The relationship between perceived discrimination and coronary artery obstruction

doi:10.1016/j.ahj.2012.01.006

American Heart Journal

Volume 163, Issue 4, April 2012, Pages 677-683

https://doi.org/10.1016/j.ahj.2012.01.006 Get rights and content

Background

Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors.

Methods

Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed. Participants were categorized as being at low/moderate or high risk for severe coronary obstruction based on results of their nuclear imaging studies. Hierarchical logistic regression models were tested separately for blacks and whites. The first step of the models included clinical factors. The second step included the psychosocial variables of optimism, religiosity, negative affect, and social support. The final step included perceived discrimination.

Results

Perceived discrimination was positively related to risk of severe obstruction among blacks but not among whites after controlling for clinical and psychosocial variables. Similar results were found in patients who underwent coronary angiography (n = 311).

Conclusions

Perceived discrimination was associated with risk of severe coronary obstruction among black male veterans and could be an important target for future interventions.

Section snippets

Study population

We used data from the Cardiac Decision Making Study, an observational cohort study of white and black veterans who had a cardiac nuclear imaging study performed between August 1999 and January 2001 at 1 of 5 Department of Veterans Affairs (VA) Medical Centers with on-site catheterization laboratories.¹⁶ Overall, 2,335 of the 5,278 patients who were screened had a positive nuclear imaging study. Of these, 981 patients were excluded because they were unable to be contacted (n = 456), had a

Descriptive statistics

Characteristics of the full sample are presented in Table I. Compared with blacks, whites were significantly older and less likely to be diagnosed with hypertension but were more likely to have had prior revascularization or prior myocardial infarction. Whites reported significantly less discrimination, negative affect, and religiosity, but significantly more social support than blacks. There were no race differences in education, optimism, and diabetes. Overall, 43.9% of participants were at

Discussion

In this study of black and white male veterans with abnormal nuclear imaging studies, we found that, among black men, greater perceptions of racial discrimination were related to increased risk for severe coronary obstruction and to angiographic coronary obstruction after controlling for clinical and psychosocial factors that are related to cardiovascular health. In addition, smoking, prior myocardial infarction, and optimism were related to nuclear imaging study results and coronary

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Such racism affects everything from the lack of resources to maintain healthy behaviours in minority neighbourhoods to the disparate treatment minorities receive when they engage with the healthcare system. The mere perception that one is being discriminated against has been associated with a higher risk of high blood pressure,18 depression,19 and coronary artery stenoses20 in Black individuals. An analysis from the third National Health and Nutrition Examination Survey found an association between the higher mortality incidence among Blacks and the higher “allostatic load” (ie, wear and tear on the body resulting from stress) they experience.21
Racism and racial bias influence the lives and cardiovascular health of minority individuals. The fact that minority groups tend to have a higher burden of cardiovascular disease risk factors is often a result of racist policies that restrict opportunities to live in healthy neighbourhoods and have access to high-quality education and healthcare. The fact that minorities tend to have the worst outcomes when cardiovascular disease develops is often a result of institutional or individual racial bias encountered when they interact with the healthcare system. In this review, we discuss bias, discrimination, and structural racism from the viewpoints of cardiologists in Canada, the United Kingdom, and the US, and how racial bias impacts cardiovascular care. Finally, we discuss proposals to mitigate the impact of racism in our specialty.
Le racisme et la discrimination raciale influent sur la vie et la santé cardiovasculaire des membres des minorités. Le fait que les groupes minoritaires tendent à présenter plus de facteurs de risque de maladies cardiovasculaires est souvent le résultat de politiques racistes qui restreignent les possibilités de vivre dans des quartiers sains et d’avoir accès à une éducation et à des soins de santé de grande qualité. Le fait que les minorités tendent à afficher les pires résultats lorsqu’une maladie cardiovasculaire se manifeste est souvent le résultat d’une discrimination raciale systémique ou individuelle à l’œuvre dans leurs interactions avec le système de santé. Dans le présent article, nous traitons de la discrimination et du racisme structurel du point de vue de cardiologues du Canada, du Royaume-Uni et des États-Unis. Nous abordons également l’incidence de la discrimination raciale sur les soins cardiovasculaires. Enfin, nous proposons certaines mesures visant à atténuer l’effet du racisme dans notre spécialité.
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Clinical InvestigationCoronary Artery DiseaseThe relationship between perceived discrimination and coronary artery obstruction

Background

Methods

Results

Conclusions

Section snippets

Study population

Descriptive statistics

Discussion

Am Heart J

J Nucl Cardiol

J Am Coll Cardiol

Soc Sci Med

Psychoneuroendocrinology

Psychoneuroendocrinology

Brain Behav Immun

Brain Behav Immun

Trends and disparities in coronary heart disease, stroke and other cardiovascular diseases in the United States: findings of the National Conference on CVD Prevention

Circulation

Socioeconomic status and chronic stress: does stress account for SES effects on health?

Ann N Y Acad Sci

Racism and cardiovascular disease in African Americans

Am J Med Sci

Racism as a stressor for African Americans: a biopsychosocial model

Am Psychol

Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN Heart Study

Psychosom Med

Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African American and European American women

Health Psychol

The two general activation systems of affect: structural findings, evolutionary considerations, and psychobiological evidence

J Pers Soc Psychol

Impact of psychological factors on the pathogensis of cardiovascular disease and implications for therapy

Circulation

Perceived racism and negative affect: analyses of trait and state measures of affect in a community sample

J Soc Clin Psychol

Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women's Health Initiative

Circulation

Clinical Investigation
Coronary Artery Disease
The relationship between perceived discrimination and coronary artery obstruction