Study details how heart disease affects black women

When it comes to heart disease, a Pitt study has found race and sex play a significant role.

On March 30, Pitt researchers published a study that has the potential to lead to a new method of screening for cardiovascular disease in middle-aged black women.

The study, which compared menopausal black and white women, found black women have higher blood levels of a protein called C-reactive protein. That protein, also known as CRP, is associated with inflammation and risk of heart disease, Norman Wang, assistant professor in the department of medicine, and Samar R. El Khoudary, assistant professor in Pitt’s Graduate School of Public Health, found in their study.

Wang and his team are currently revisiting the manuscript from a follow-up study, and said he hopes to have the research published by December 2016.

“Right now one of the main issues is trying to figure out sex- and race-specific screening for coronary artery disease, because we know that people of different sex and race have different risks of coronary disease,” Wang said. “It’s basically trying to figure out what else might be going on in these specific subgroups that leads to a higher risk.”

The study showed that black and white women without plaque buildup, or calcification, in their hearts had similar levels of CRP. A difference in CRP levels emerged between black and white women who did have plaque buildup. As a result, black women at risk for heart disease will likely have high CRP levels in their blood, a phenomenon not seen in white women.

This indicates that future research could focus on developing a new heart disease screening method for menopausal black women.

“Among white women and black women who do not have calcification, the CRP levels are the same,” El Khoudary said. “If the woman was black and had higher CRP levels, then the calcification would be higher.”

According to the United States National Library of Medicine, one in four women die of heart disease each year.

Wang said many studies into cardiovascular disease use white men as subjects, which has led to a set of “traditional risk factors” for heart disease such as age, history of smoking and hypertension. The problem with this, according to Wang, is that non-white, non-male individuals with heart disease may never have the traditional risk factors.

“When you look at middle-aged women who go on to have either a heart attack or require a stent for heart disease leading to chest pain, about 10 percent have no traditional risk factors, and over 33 percent have [only] one traditional risk factor,” Wang said.

Because diseases affect various demographics of people differently, medical research must be conducted with a variety of racial and gender groups, according to Kathryn Berlacher, assistant professor in Pitt’s department of medicine. Berlacher said without such research, doctors may fail to correctly identify patients’ risk for diseases such as heart disease.

“What this study is potentially calling us to say is that we potentially would have missed a 60-year-old black woman, who we would otherwise have applied the traditional risk factors of cardiovascular disease [to] and said, ‘Oh, good news, you’re not at risk,’” Berlacher said.

Patients who are misdiagnosed or underdiagnosed, such as women with undiagnosed heart disease, will not receive the care they need to treat or prevent their health issues, according to Berlacher.

“If you can’t identify somebody as a slightly higher risk, then they get poor treatment,” Berlacher said. “This type of research is really important for [doctors and researchers] to identify what our shortcomings are.”

To continue research into this topic, Wang said he and his team conducted the second part of the current study and looked at how plaque buildup changes with various treatments, such as taking aspirin.

Berlacher said she hopes studies like Wang’s will allow for better, more specialized assessment and treatment of cardiovascular disease for a wider range of patients.

“This type of research, where we actually look at what different risk factors are for each population, really personalizes and customizes medicine,” Berlacher said.