Focus placed on key health needs of African-Americans

Washington -- "It's a wake-up call."

At least that's how the majority of respondents in a recent survey of 502 African-Americans described their first heart attack. But the survey also determined that this alarm failed to inspire many of those questioned to take action to ward off a second, thus setting up a puzzling health care disconnect and highlighting some of the continuing areas of concern regarding minority patient populations.

The National Medical Assn.'s survey found that 64% of those queried viewed their survival as providing a second chance at life, but 22% were not taking their medications as prescribed, and 26% were not seeing their physicians regularly.

Clyde Yancy, MD, medical director of Baylor University's Heart and Vascular Institute in Dallas, presented the data during a Jan. 16 briefing sponsored by the National Medical Assn. In addition to cardiovascular disease, the event focused on asthma and diabetes. The three take a major toll on the health of African-Americans.

The possible reasons behind these survivors' lack of attention to their medical care cover a broad set of disparity concerns. Dr. Yancy speculated that these could range from socioeconomic issues, such as the cost of medications and doctor visits, to cultural issues, such as trust in physicians or concern about drug side effects. The survey did not ask patients why they didn't take specific steps to prevent future heart attacks.

But 27% of the survivors reported that they did not have enough information on what to do to prevent more heart attacks. The majority, 83%, said speaking to another heart attack survivor would be helpful.

Cardiovascular disease poses a major risk for African-Americans, Dr. Yancy said, and one that is not as widely recognized as it should be. Its prevalence in 2004 was 44.6% among black males compared with 37.2% among white males, according to the American Heart Assn. Among black females, the prevalence rate was 49% compared with 35% for white females.

One factor that is key to the proper care of this population is access to physicians, Dr. Yancy said.

In addition, unless the disease is imminent and acute, many people have the perception that they lack time or resources to see a physician, he said.

Since the disease poses a significantly greater risk for black men and women than for their white counterparts, screening should begin earlier in this population, in patients' 20s and 30s, and prevention and treatment pursued more aggressively, Dr. Yancy said.

Physicians should make sure that African-American patients receive guideline-recommended, evidence-based therapies, he said.

Race-based medicine

Whether specific drugs work better for African-Americans is still a matter of debate, he noted. "There may be nuances of differences among individuals regarding sensitivities. We are getting closer to pharmacogenetics to help us understand this better."

Type 2 diabetes is another disease that disproportionately affects blacks and other minority populations, and it is intrinsically linked to heart disease, said Samuel Dagogo-Jack, MD, professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee's Center for Health Sciences in Memphis. He provided information on this disease at the briefing.

Currently 3.2 million African-Americans have the disease, or about 13% of the adult black population, he said. Among Latinos, 2.5 million have type 2 diabetes, or about 10% of the adult population.

"Many do not recognize that having a diagnosis of diabetes carries the same risk as already having one heart attack," Dr. Dagogo-Jack said.

The fact that type 2 diabetes, which affects growing numbers of people, does not develop overnight provides a window of opportunity to intervene with lifestyle changes to lower the risk of developing the full-fledged disease, he noted.

This incipient stage, called pre-diabetes, where blood sugar levels are higher than normal but not high enough for a diagnosis, can last for several years.

Pairing that information with the fact that African-Americans have high levels of insulin resistance can help a physician build a persuasive case for patients to make improvements in their diets and exercise habits. Research has shown that such lifestyle changes can produce spectacular successes in the body's use of insulin, he said.

Also, for patients who already have type 2 diabetes, physicians should prescribe the medications that most effectively boost the body's ability to handle insulin. "It makes sense to use those agents with a foundation of diet and exercise," Dr. Dagogo-Jack said.

The impact of asthma on the black community was also covered in the briefing. African-Americans have the highest prevalence rate of asthma among all racial and ethnic groups, said Michael LeNoir, MD, chair of the National Medical Assn.'s Asthma and Allergy Initiative, and an Oakland, Calif., pediatrician specializing in allergies.

Blacks represent 12% of the nation's population but 26% of all asthma deaths, he said. Since asthma can be controlled with proper care, "no one should die of this disease."