Black-White Disparities in Angiographic Coronary Artery Disease and Associations with Hypertension

Introduction: Black Americans have a higher mortality rate from coronary artery disease (CAD) than whites, which may reflect a greater risk factor burden, increased barriers to care, lower socioeconomic status and differences in treatment. However, several studies have shown that despite a higher mortality rate and clinical burden of disease, black patients referred for angiography are less likely to have detected coronary stenoses than whites. This review is an attempt to summarize the evidence from the literature that examines black-white differences in angiographic disease. Methods: A systematic search strategy was used to identify articles which address the topic of interest. Eligible articles were reviewed for quality using a pre-specified and validated method of quality assessment. Important study characteristics and study findings were also examined for included articles. Results: Eight articles met all eligibility criteria and were included in this review. The majority (6) of the articles were given moderate quality ratings for internal validity, while the applicability of the studies to the key question of the review varied. Six of the articles reported a significantly lower rate of angiographic CAD in blacks compared to whites, one reported mixed findings and a single study found no differences between the race groups. Conclusions: There is fair evidence that black patients referred for angiography are less likely than whites to have significant CAD. This finding has important implications for future research to examine explanations for this finding as well as the clinical and prognostic value of angiography in blacks compared to whites.