Clark Luther T
Division of Cardiovascular Medicine, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
Med Clin North Am. 2005 Sep;89(5):977-1001, 994. doi: 10.1016/j.mcna.2005.05.001.
Cardiovascular disease (in particular, CHD) is the leading cause of death in the United States for Americans of both sexes and of all racial and ethnic backgrounds. African Americans have the highest overall CHD mortality rate and the highest out-of-hospital coronary death rate of any ethnic group in the United States, particularly at younger ages. Contributors to the earlier onset of CHD and excess CHD deaths among African Americans include a high prevalence of coronary risk factors, patient delays in seeking medical care, and disparities in health care. The clinical spectrum of acute and chronic CHD in African Americans is the same as in whites; however, African Americans have a higher risk of sudden cardiac death and present clinically more often with unstable angina and non-ST-segment elevation myocardial infarction than whites. Although generally not difficult, the accurate diagnosis and risk assessment for CHD in African Americans may at times present special challenges. The high prevalence of hypertension and type 2 diabetes mellitus may contribute to discordance between symptomatology and the severity of coronary artery disease, and some noninvasive tests appear to have a lower predictive value for disease. The high prevalence of modifiable risk factors provides great opportunities for the prevention of CHD in African Americans. Patients at high risk should be targeted for intensive risk reduction measures, early recognition/diagnosis of ischemic syndromes, and appropriate referral for coronary interventions and cardiac surgical procedures. African Americans who have ACSs receive less aggressive treatment than their white counterparts but they should not. Use of evidence-based therapies for management of patients who have ACSs and better understanding of various available treatment strategies are of utmost importance. Reducing and ultimately eliminating disparities in cardiovascular care and outcomes require comprehensive programs of education and advocacy(Box 4) with the goals of (1) increasing provider and public awareness of the disparities in treatment; (2) decreasing patient delays in seeking medical care for acute myocardial infarction and other cardiac disorders; (3) more timely and appropriate therapy for ACSs; (4) improved access to preventive, diagnostic, and interventional cardiovascular therapies; (5) more effective implementation of evidence-based treatment guidelines; and (6) improved physician-patient communications.
心血管疾病（尤其是冠心病）是美国所有性别、种族和族裔背景的美国人的首要死因。非裔美国人的总体冠心病死亡率最高，院外冠心病死亡率在美国所有族裔群体中也是最高的，特别是在较年轻年龄段。导致非裔美国人冠心病发病较早和冠心病死亡过多的因素包括冠心病危险因素的高流行率、患者就医延迟以及医疗保健方面的差异。非裔美国人急性和慢性冠心病的临床谱与白人相同；然而，非裔美国人心脏性猝死的风险更高，临床上比白人更常表现为不稳定型心绞痛和非ST段抬高型心肌梗死。虽然一般来说并不困难，但对非裔美国人冠心病的准确诊断和风险评估有时可能会带来特殊挑战。高血压和2型糖尿病的高流行率可能导致症状与冠状动脉疾病严重程度之间不一致，一些非侵入性检查对疾病的预测价值似乎较低。可改变的危险因素的高流行率为非裔美国人预防冠心病提供了巨大机会。高危患者应成为强化风险降低措施、早期识别/诊断缺血综合征以及适当转诊进行冠状动脉介入治疗和心脏外科手术的目标人群。患有急性冠状动脉综合征的非裔美国人比白人接受的积极治疗更少，但他们不应如此。对患有急性冠状动脉综合征的患者使用循证疗法并更好地了解各种可用治疗策略至关重要。减少并最终消除心血管护理和治疗结果方面的差异需要全面的教育和宣传计划（方框4），目标是：（1）提高医疗服务提供者和公众对治疗差异的认识；（2）减少患者因急性心肌梗死和其他心脏疾病就医的延迟；（3）对急性冠状动脉综合征进行更及时和适当的治疗；（4）改善获得预防性、诊断性和介入性心血管治疗的机会；（5）更有效地实施循证治疗指南；（6）改善医患沟通。
