The research proposed in this application will address a series of major questions related to the clinical epidemiology of coronary artery disease (CAD) among black women. Funds are requested to continue an on going study involving 2,806 black men and women who have been enrolled in a hospital-based registry; examination of the survival patterns and related risk factors in the cohort of 1,559 black women will be the primary focus of this project. Black women in the US suffer age-adjusted death rates from CAD that are 24% higher than found among white women. In addition, the relative gender-related advantage experienced by black women for CAD is much less than among whites. Very limited data currently exist on the clinical course Of CAD among black women. It appears from existing data, however, that incidence rates, acute case-fatality, and long-term survival are all worse than among white women. High rates of hypertension, left ventricular hypertrophy and diabetes may provide a partial explanation for these findings. Although these medical conditions have been widely studied among men, no data exist to our knowledge among black women. Our preliminary analyses indicate that among blacks with coexistent CAD and diabetes a strong """"""""gender by disease state"""""""" interaction exists, suggesting that information from other population groups cannot provide the basis for direct inference to black women. Additional support is requested to extend the follow-up on this large cohort for another three years. Within this period the accumulated number of events will permit detailed survival analyses by sex, and allow us for the first time to investigate the impact of the risk factors mentioned above among black women. In addition, a short-term follow-up study of a population sample of black with chest pain is proposed.
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