Study Suggests Perceived Discrimination Associated with Risk of Severe Coronary Obstruction among African American Veterans
BACKGROUND:
Cardiovascular disease affects disproportionately more African Americans than whites in the U.S., but the sources of this disparity are not clearly understood. As an unpredictable and uncontrollable stressor, perceived racial discrimination can elicit psychological responses (e.g., increased blood pressure) that can degrade health over time and result in cardiovascular disease. This study focused on the relationship between perceived discrimination and the risk of severe coronary obstruction among male Veterans. Using data from an observational study of white and African American Veterans who had a cardiac nuclear imaging study performed between 8/99 and 1/01 at one of five VAMCs, investigators identified 793 Veterans (629 whites and 164 African Americans), in addition to a subset of 311 Veterans (259 whites and 52 African Americans) who had coronary angiography within 90 days of their imaging study. Measures included: sociodemographics, clinical variables (e.g., comorbid conditions), perceived discrimination in several domains (e.g., school, work, housing, healthcare), psychosocial variables, and risk of severe coronary obstruction.
FINDINGS:
- Compared to white Veterans, African American Veterans with abnormal nuclear imaging studies had greater perceptions of racial discrimination that were related to increased risk for severe coronary obstruction — and to angiographic coronary obstruction, after controlling for clinical and psychosocial factors related to cardiovascular health.
- Based on their nuclear imaging studies, 44% of Veterans (both whites and African Americans) were at high risk for severe coronary obstruction.
- Among both African American and white Veterans, prior myocardial infarction (MI) and smoking were associated with high (vs. low/moderate) risk for severe coronary obstruction, while optimism was related to a decreased risk of severe obstruction.
- No significant associations between social support, negative affect, or religiosity and results from nuclear imaging or coronary angiography were found.
LIMITATIONS:
- The study sample included only men with positive nuclear imaging study results — a population selected to be at high risk for coronary disease.
- Data were cross-sectional, thereby precluding any causal interpretations.
- Investigators did not account for a number of clinical variables that are associated with risk of coronary obstruction (e.g., various cholesterol subsets).
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (ECV 970-022, RCS 02-066, RCD 06-287). Dr. Hausmann is an HSR&D Career Development Awardee and part of HSR&D's Center for Health Equity Research and Promotion, Pittsburgh, PA. Dr. Kressin is an HSR&D Senior Research Career Scientist at the VA Boston Healthcare System.
Ayotte B, Hausmann L, Whittle J, and Kressin N. The Relationship between Perceived Discrimination and Coronary Artery Obstruction. American Heart Journal April 2012;163(4):677-83.
