Coronary heart disease (CHD) accounts for 23% of deaths among black Americans and is the most common cause of death. CHD death rates are substantially higher among blacks than whites and the differential is increasing. If current trends persist, by the year 2000 rates will be 40% higher for black men and 60% higher for black women compared to their white counterparts. In addition to these trends, a variety of studies demonstrate a survival disadvantage for black patients with symptomatic CHD. Not only is access to care more limited for blacks, even within health systems where financial barriers are eliminated, mortality rates for each level of disease severity are higher. Over the next phase of this research in a cohort of 2500 patients from a single public institution, the investigators propose to accomplish two primary aims. First, they will continue to follow the original cohort to examine the interaction of left ventricular hypertrophy (LVH) and mortality risk in the subgroup of patients with CHD, to investigate further the impact of left ventricular geometry on survival, and to define the prognostic significance of obesity. Second, the investigators will enroll a new clinical cohort of 5,600 patients, approximately equally divided between blacks and whites, from Louisiana State University (LSU) Medical Center. The survival patterns of these groups will be compared directly, and the contribution of LVH to the black:white differential estimated. The new cohort will serve as a validation sample for the hypotheses derived from the original cohort. Many of the basic aspects of the clinical epidemiology of CHD among blacks remain poorly defined. Attempts to design appropriate intervention strategies must be based on observational studies of sufficient size and duration to provide unambiguous estimates of the major contributors to excess mortality among black patients with CHD and among whites with CHD and LVH. This project should provide definitive answers to a set of major questions in the clinical epidemiology of CHD.
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