Racial Disparities in Cardiovascular Care Persist for Postmenopausal Women

Tarryn Tertulien, BS

Investigators have found that despite improvements in women’s cardiovascular health care, black women still face disparities in care compared to white and Hispanic women.

The study, which looked at heart attack and heart disease care in women after menopause, found disparities in revascularization for women with myocardial infarction, acute coronary syndrome, and chronic heart disease.

"Our study shows that black women still receive less recommended therapy for heart attacks and coronary heart disease than white women and that improving these racial disparities is still needed," said Tarryn Tertulien, BS, lead study author and a fourth-year medical student at The Warren Alpert Medical School at Brown University in Providence, Rhode Island.

The investigators pulled data from the Women’s Health Initiative to compare women’s cardiovascular treatment rates before and after 2005, to evaluate the effects of the implementation of a 2002 guideline update. The authors chose 2005 as the year to split the data because guidelines generally take 2 to 3 years to be fully implemented. The study included treatment data for 20,262 postmenopausal women including 17,509 white, 2181 black, and 572 Hispanic women.

They found that despite improvements in cardiovascular care overall after 2005, among postmenopausal women, black women were 50% less likely to be treated when arriving at a hospital with symptoms of a heart attack or coronary artery disease, compared to white women. Hispanic women were 16% less likely to be treated in that scenario compared to white women. The gap in treatment rates remained after investigators accounted for factors including education, income, insurance status, and cardiovascular health complications such as diabetes and high blood pressure.

Black women with acute coronary syndrome or chronic heart disease were significantly less likely to be treated compared to white women (before 2005, Hazard Ratio [HR] .58, 95% Confidence Interval [CI] .52 — .65; after 2005, HR .52, 95% CI .45 – .61; for both, P <0.05). For Hispanic women compared to white women, the gap narrowed from a HR of .74 (95% CI .61 - .89; P <0.05) before 2005 to HR .84 (95% CI .67 — 1.05) after 2005.

Additionally, black women with a ST-elevation myocardial infarction (STEMI) had treatment rates 15% lower before 2005 and 39% lower after 2005, compared to white women with the same condition.

"Increasing public campaigns targeted at racial minorities regarding patient education and developing a trusting relationship with the healthcare system should be instituted to improve this disparity in care," added Tertulien.

While the study did not address causes for the disparities it found, Tertulien suggested that black and Hispanic patients may be less familiar with common symptoms of heart attacks or may be less likely than white women to use emergency services. She noted that there may also be provider biases involved in creating the care disparities.

The abstract, “Secular Trends in Racial and Socioeconomic Status Disparities in the Rate of Coronary Revascularization Among Post-Menopausal Women Before and After 2005 for Acute Coronary Syndrome: The Women Health Initiative,” was presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019 in Arlington, Virginia.