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Anginal symptoms, coronary artery disease, and adverse outcomes in Black and White women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.
J Womens Health (Larchmt) 2013; 22(9):724-32JW

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

(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).

CONCLUSIONS

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.

Authors+Show Affiliations

School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA. jeastwoo@sonnet.ucla.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23992103

Citation

Eastwood, Jo-Ann, et al. "Anginal Symptoms, Coronary Artery Disease, and Adverse Outcomes in Black and White Women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) Study." Journal of Women's Health (2002), vol. 22, no. 9, 2013, pp. 724-32.
Eastwood JA, Johnson BD, Rutledge T, et al. Anginal symptoms, coronary artery disease, and adverse outcomes in Black and White women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. J Womens Health (Larchmt). 2013;22(9):724-32.
Eastwood, J. A., Johnson, B. D., Rutledge, T., Bittner, V., Whittaker, K. S., Krantz, D. S., ... Bairey Merz, C. N. (2013). Anginal symptoms, coronary artery disease, and adverse outcomes in Black and White women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. Journal of Women's Health (2002), 22(9), pp. 724-32. doi:10.1089/jwh.2012.4031.
Eastwood JA, et al. Anginal Symptoms, Coronary Artery Disease, and Adverse Outcomes in Black and White Women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) Study. J Womens Health (Larchmt). 2013;22(9):724-32. PubMed PMID: 23992103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anginal symptoms, coronary artery disease, and adverse outcomes in Black and White women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. AU - Eastwood,Jo-Ann, AU - Johnson,B Delia, AU - Rutledge,Thomas, AU - Bittner,Vera, AU - Whittaker,Kerry S, AU - Krantz,David S, AU - Cornell,Carol E, AU - Eteiba,Wafia, AU - Handberg,Eileen, AU - Vido,Diane, AU - Bairey Merz,C Noel, Y1 - 2013/08/30/ PY - 2013/9/3/entrez PY - 2013/9/3/pubmed PY - 2014/2/7/medline SP - 724 EP - 32 JF - Journal of women's health (2002) JO - J Womens Health (Larchmt) VL - 22 IS - 9 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: (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). CONCLUSIONS: 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. SN - 1931-843X UR - https://www.unboundmedicine.com/medline/citation/23992103/Anginal_symptoms_coronary_artery_disease_and_adverse_outcomes_in_Black_and_White_women:_the_NHLBI_sponsored_Women's_Ischemia_Syndrome_Evaluation__WISE__study_ L2 - https://www.liebertpub.com/doi/full/10.1089/jwh.2012.4031?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -