Abstract
The issue of race in medicine is problematic. Race is not a physiologic grouping, and all persons of a given race do not necessarily share the same clinical phenotype or genetic substrate. Despite clear signals that certain risk factors and diseases vary as a function of race, translating those differences into race-based therapeutics has been awkward and has done little to change the natural history of cardiovascular disease as it affects special populations. Among the varied special populations, the African American population appears to have the most significant and adverse variances for cardiovascular disease as well as worrisome signals that drug responsiveness varies. Recent guideline statements have now acknowledged certain treatment options that are most appropriate for African Americans with cardiovascular disease, especially hypertension and heart failure. As more physiologic markers of disease and drug responsiveness become available, the need for racial designations in medicine may lessen, and therapies can be optimized for all patients without regard to race or ethnicity.
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References and Recommended Reading
Williams DR, Rucker TD: Understanding and addressing racial disparities in health care. Health Care Financ Review 2000, 21:75–90.
American Heart Association. 2003 Heart Disease and Stroke Statistics-Update. Dallas TX: American Heart Association; 2002.
American Heart Association. Heart Disease and Stroke Statistics—2008 Update. Dallas, TX: American Heart Association; 2008.
Yancy CW: Heart failure in African Americans: a cardiovascular engima. J Card Fail 2000, 6:183–186.
Chobanian AV, Bakris GL, Black HR, et al.: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206–1252.
Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003, 290:199–206.
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997, 157:2413–2446.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998, 317:703–713. [Published erratum appears in BMJ 1999, 318:29.]
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997. [Published errata appears in JAMA 2003, 289:178 and JAMA 2004, 291:2196.]
Wright JT, Bakris G, Greene T: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease. Results from the AASK trial. JAMA 2002, 288:2421–2431.
Prisant LM, Neutel JM, Ferdinand K, et al.: Low-dose combination therapy as first-line hypertension treatment for blacks and nonblacks. J Natl Med Assoc 1999, 91:40–48.
Douglas JG, Bakris GL, Epstein M, et al.: Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 2003, 163:525–541.
Hunt SA, Abraham WT, Chin MH, et al.: ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005, 112:e154–e235.
Dries DL, Exner DV, Gersh BJ, et al.: Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999, 340:609–616.
Yancy CW: Heart failure in African Americans. Am J Cardiol 2005, 96(7B):3i–12i.
Taylor AL, Ziesche S, Yancy C, et al.: Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med 2004, 351:2049–2057.
Exner DV, Dries DL, Domanski MJ, et al.: Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med 2001, 344:1351–1357.
Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153. [Published errata appear in N Engl J Med 2000, 342:748 and N Engl J Med 2000, 342:1376.]
Cohn JN, Tognoni G, Glazer R, Spoprmann D: Baseline demographics of the Valsartan Heart Failure Trial. Val-HeFT Investigators. Eur J Heart Fail 2000, 345:1667–1675.
Pfeffer MA, Swedberg K, Granger CB, et al.; CHARM Investigators and Committees: Effects of candesartan on mortality and morbidity in patients with chronic heart failure: The CHARM Overall Programme. Lancet 2003, 362:759–766.
Julius S, Weber M, Kjeldsen S, et al.: The Valsartan Antihypertension Long Term Use Evaluation [VALUE] Trial: outcomes in patients receiving monotherapy. Hypertension 2006, 48:385–391.
Shekelle PG, Rich MW, Morton SC, et al.: Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials. J Am Coll Cardiol 2003, 41:1529–1538.
The Beta-Blocker Evaluation of Survival Trial Investigators: A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001, 344:1659–1667.
Andreka P, Aiyar N, Olson LC, et al.: Bucindolol displays intrinsic sympathomimetic activity in human myocardium. Circulation 2002, 105:2429–2434.
Yancy CW, Fowler MB, Colucci WS, et al.: Race and the response to adrenergic blockade with carvedilol in patients with heart failure. N Engl J Med 2001, 344:1358–1365.
Carson P, Fowler MB, Mohacsi P, et al.: Effect of carvedilol in black patients with severe chronic heart failure: results of the COPERNICUS Study [abstract]. Circulation 2001, 104(Suppl II):II–754.
Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999, 353:2001–2007.
Zheng ZJ, Croft JB, Giles WH, Mensah GA: Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001, 104:2158–2163.
Hjalmarson A: Prevention of sudden cardiac death with beta blockers. Clin Cardiol 1999, 22(Suppl 5):V11–V15.
McMurray J, Kober L, Robertson M, et al.: Antiarrhythmic effect of carvedilol after acute myocardial infarction Results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial. J Am Coll Cardiol 2005, 45:525–530.
Abraham WT, Massie BM, Franciosa JA, et al.: Tolerability, safety, and efficacy of beta-blockade in black patients with heart failure in the community setting: Insights from a large prospective beta-blocker registry. Presented at the Heart Failure Society of America 7th Annual Scientific Meeting; September 22, 2003; Las Vegas, NV [abstract 348]. J Card Fail 2003, 9(Suppl 1):S94.
Cohn JN, Archibald MP, Ziesche S, et al.: Effect of vasodilator therapy on mortality in chronic congestive heart failure. N Engl J Med 1986, 314:1547–1552
Pierpont GL, Cohn JN, Franciosa JA, et al.: Combined oral hydralazine-nitrate therapy in left ventricular failure: hemodynamic equivalency to sodium nitroprusside. Chest 1978, 73:8–13
Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapri with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:303–310.
Carson P, Ziesche S, Johnson G, et al.: Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. J Card Fail 1999; 5:178–187.
Yancy CW, Ghali JK, Braman VM, et al.: Results of the extension to A-HeFT [X-A-HeFT] support the continued safety and tolerability of fixed dose isosorbide dinitrate/hydralazine. J Card Fail 2006, 12:S80.
Kahn DF, Duffy SJ: Effects of black race on forearm resistance vessel function. Hypertension 2002, 40:195–201.
Cardillo C, Kilcoyne CM, Cannon RO, et al.: Racial differences in nitric oxide-mediated vasodilator response to mental stress in the forearm circulation. Hypertension 1998, 31:1235–1239.
Kalinowski L, Dobrucki, IT, Tomasian D, et al.: Race-specific differences in endothelial function: predisposition of African Americans to vascular disease. Circulation 2004, 109:2511–2517.
Prabhu SD: Nitric oxide protects against pathological ventricular remodeling: reconsideration of the role of NO in the failing heart. Circ Res 2004, 94:115–157.
Hare JM: Nitroso-redox balance in the cardiovascular system. N Engl J Med 2004, 351:2112–2114.
Malinski T: Understanding nitric oxide physiology in the heart: a nanomedical approach. Am J Cardiol 2005, 96(Suppl):13i–24i.
Wollert KC, Drexler H: Regulation of cardiac remodeling by nitric oxide: focus on cardiac myocyte hypertrophy and apoptosis. Heart Fail Rev 2002, 7:317–325.
Janssens S, Pokreisz P, Schoonjans L, et al.: Cardiomyocytespecific overexpression of nitric oxide synthase 3 improves left ventricular performance and reduces compensatory hypertrophy after myocardial infarction. Circ Res 2004, 94:1256–1262.
McNamara DM, Tam SW, Sabolinski ML, et al.: Aldosterone synthase promoter polymorphism predicts outcome in African Americans with heart failure: results from the A-HeFT Trial. J Am Coll Cardiol 2007, 48:1277–1282.
Peterson ED, Shaw LK, DeLong ER, et al.: Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med 1997, 336:480–486.
Turner ST, Schwartz GL, Chapman AB, Boerwinkle E: C825T polymorphism of the G protein beta(3)-subunit and antihypertensive response to a thiazide diuretic. Hypertension. 2001, 37:739–743.
Suthanthiran M, Li B, Song JO, et al.: Transforming growth factor-beta1 hyperexpression in African-American hypertensives: a novel mediator of hypertension and/or target organ damage. Proc Natl Acad Sci 2000, 97:3479–3484.
Mason DA, Moore JD, Green SA, Liggett SB: A gain-offunction polymorphism in a G-protein coupling domain of the human beta1-adrenergic receptor. J Biol Chem. 1999, 274:12670–12674.
Small KM, Wagoner LE, Levin AM, et al.: Synergistic polymorphisms of beta1-and alpha2C-adrenergic receptors and the risk of congestive heart failure. N Engl J Med 2002, 347:1135–1142.
McNamara D: Pharmacogenetics in heart failure: genomic markers of endothelial and neurohumoral function. Congest Heart Fail 2004, 10:302–308.
McNamara DM, Holubkov R, Postava L, et al.: Pharmacogenetic interactions between angiotensin-converting enzyme inhibitor therapy and the angiotensin-converting enzyme deletion polymorphism in patients with congestive heart failure. J Am Coll Cardiol 2004, 44:2019–2026.
McNamara DM, Holubkov R, Postava L, et al.: Effect of the Asp298 variant of endothelial nitric oxide synthase on survival for patients with congestive heart failure. Circulation 2003, 107:1598–1602.
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Yancy, C.W. Race-based therapeutics. Current Science Inc 10, 276–285 (2008). https://doi.org/10.1007/s11906-008-0052-8
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DOI: https://doi.org/10.1007/s11906-008-0052-8