The clinical course of coronary artery disease (CAD) among blacks in the U.S. has not been well studied. A better understanding of the clinical epidemiology of CAD in this population would be important for several reasons. First, there is evidence that blacks suffer higher case-fatality rates from CAD and have shorter survival once symptoms have appeared. Second, additional evidence is available to suggest that blacks have limited access to medical care for this disease, including notably acute coronary care and bypass surgery. Delineation of the clinical course of CAD among blacks would make it possible to assess the potential importance of this problem. Finally, study of CAD in a group with a high prevalence of hypertension and a marked increased risk among women may yield additional information about the biology of this disease process. We propose to recruit, characterize and follow long-term (up to 2 years) a cohort of 1000 black patients with symptomatic CAD. Patients will be entered into the study after one of three events: myocardial infarction (MI), new onset angina, or cardiac catheterization (during which CAD is demonstrated). An additional sub-group of patients who have undergone coronary artery bypass surgery (CABG) will be followed. Key end-points will include: 1) Case fatality rates from acute events; 2) Long-term survival rates; 3) Sudden vs. non-sudden death rates; 4) Occurrence of first MI among patients with new onset angina; 5) Functional recovery after MI and CABG. The value of baseline characteristics as predictors of mortality will be assessed. Two control groups will be recruited to provide comparisons of baseline findings and the end-points defined above. One control group will consist of patients undergoing cardiac catheterization for chest pain who are found to have normal coronary arteries and the second will be patients who have been diagnosed to have mild/moderate hypertension and no apparent CAD. One hundred fifty patients from each of these control groups will be followed long-term, primarily through surveillance of government vital status records. This study will provide the first comprehensive data set on the clinical course of CAD in the poor and working class black population of the urban U.S.
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