School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA.
J Womens Health (Larchmt). 2013 Sep;22(9):724-32. doi: 10.1089/jwh.2012.4031. Epub 2013 Aug 30.
Black women are less likely to be evaluated and treated for anginal symptoms, despite a higher premature cardiac mortality rate compared to white women. Our objective was to compare angina symptoms in black versus white women regarding (1) angina symptoms characterization; (2) relationship with obstructive coronary artery disease (CAD); and (3) relationship with subsequent mortality.
A cohort of 466 women (69 black and 397 white) undergoing coronary angiography for suspected ischemia and without prior history of CAD completed symptom checklists. Four symptom clusters (CHEST, UPPER, STOMACH, and TYPICAL TRIGGERS) were derived by factor analysis. All angiograms were analyzed by core lab. Mortality data over 10 years were obtained from National Death Index.
(1) Black women had lower mean CHEST cluster scores (0.60±0.30 vs. 0.73±30, p=0.002), but higher STOMACH scores (0.41±0.25 vs. 0.30±0.25, p=0.011) than white women. (2) Prevalence and severity of CAD did not differ in black and white women and was not predicted by symptom cluster scores. (3) All-cause mortality rates were 24.9% in blacks versus 14.5% in whites, p=0.007; and cardiovascular mortality 22.5% vs.8.8%, p=0.001. Symptom clusters were not predictive of adverse events in white women. However, black women with a low TYPICAL score had significantly higher mortality compared to those with a high TYPICAL score (43% vs. 10%, p=0.006).
Among women undergoing coronary angiography, black women report fewer chest-related and more stomach-related symptoms, regardless of presence or severity of CAD, and these racial symptom presentation differences are linked with the more adverse prognosis observed in the black women. Atypical symptom presentation may be a barrier to appropriate and timely diagnosis and treatment and contribute to poorer outcomes for black women.
与白人女性相比，黑人女性心绞痛的评估和治疗可能性较低，尽管其过早的心脏死亡率更高。我们的目的是比较黑人和白人女性的心绞痛症状，包括（1）心绞痛症状特征；（2）与阻塞性冠状动脉疾病（CAD）的关系；（3）与随后死亡率的关系。
一个由 466 名女性（69 名黑人，397 名白人）组成的队列，因疑似缺血而行冠状动脉造影检查，且无 CAD 既往史，完成了症状清单。通过因子分析得出四个症状群（胸部、上半身、胃部和典型诱因）。所有血管造影均由核心实验室进行分析。通过国家死亡索引获得 10 年的死亡率数据。
（1）黑人女性的平均胸部症状群评分（0.60±0.30 与 0.73±0.30，p=0.002）较低，但胃部症状群评分（0.41±0.25 与 0.30±0.25，p=0.011）较高。（2）黑人女性与白人女性的 CAD 患病率和严重程度没有差异，也不受症状群评分的预测。（3）黑人女性的全因死亡率为 24.9%，白人女性为 14.5%，p=0.007；心血管死亡率分别为 22.5%和 8.8%，p=0.001。在白人女性中，症状群对不良事件没有预测作用。然而，低典型评分的黑人女性死亡率明显高于高典型评分的黑人女性（43%与 10%，p=0.006）。
在接受冠状动脉造影检查的女性中，无论 CAD 的存在或严重程度如何，黑人女性报告的胸部相关症状较少，胃部相关症状较多，这些种族症状表现差异与黑人女性更不利的预后有关。非典型症状表现可能是适当和及时诊断和治疗的障碍，并导致黑人女性的预后较差。
