Disparities in Cardiovascular Disease Risk and Treatment

BACKGROUND: Cardiovascular morbidity and mortality can be prevented by identification and modification of specific risk factors. Ethnic minorities have a higher incidence of cardiovascular risk factors. Additionally, ethnic minorities often reside in medically underserved areas and are subject to health care disparities. We hypothesized that ethnic minorities residing in medically underserved areas would experience greater health care disparities related to cardiovascular disease (CVD) prevention and treatment compared with those residing near an urban academic medical center. METHODS: We performed a retrospective chart review (N = 200) comparing an urban academic medical center with a rural community center. We evaluated the effects of ethnicity, demographics, and the absence or presence of CVD on cardiovascular risk factor prevalence, risk factor reduction, and CVD prevention and treatment. RESULTS: We found that Hispanics had more cardiovascular risk factors, including diabetes mellitus and low high-density lipoprotein cholesterol, compared with non-Hispanic whites. However, there were no ethnically based differences in risk factor prevalence by location. Additionally, ethnicity had no impact on the management of cardiovascular risk factors. However, patients with CVD residing in the rural location, regardless of ethnicity, received significantly fewer secondary prevention treatments compared with patients residing near the urban academic medical center, including aspirin or antiplatelets (p < .0001); beta-blockers or calcium channel blockers (p < or = .0001); diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers (p = .014); and statins (p < or = .0001). CONCLUSIONS: Hispanics have more CVD risk factors than non-Hispanic whites but receive equivalent prevention initiatives. Residing in a rural, medically underserved area, regardless of ethnicity, was associated with the largest CVD treatment and health care disparity.