Medical Device Daily Washington Editor
WASHINGTON – Device makers know that heart disease is a growing area of concern, and so do members of the American Public Health Association (APHA; Washington), which included a session on the epidemiology of heart disease in one of its Wednesday sessions. One presenter confirmed the long-held suspicion that those who suffer from a well-known and severe lung disease are indeed more likely to have cardiovascular disease and another presenter showed that a substantial amount of data suggests that depression can have a discernible impact on how patients report their health.
Joseph Finklestein, MD, a professor of epidemiology at the University of Maryland Medical Center (Baltimore), reviewed the correlation of chronic obstructive pulmonary disorder (COPD, which is the coexistence of chronic bronchitis and emphysema) and cardiovascular morbidity.
Finklestein noted that COPD “is the fourth leading cause of death in the U.S.” and is projected “to be the third leading cause of death by 2020.” However, data suggests that non-respiratory disease accounts for more than half the deaths of COPD patients, and recent studies suggest a link between COPD and cardiovascular disease. He based these remarks on data provided by an annual survey conducted by the Centers for Disease Control and Prevention (CDC; Atlanta), the National Health Interview Survey.
Finklestein’s objective was to measure the prevalence of COPD across age groups and to establish whether the condition is an identifiable risk factor in cardiovascular disease (CVD). The diagnosis of CVD was assigned based on the diagnosis of the respondent’s physician, and data from respondents younger than the age of 40 were not included in this analysis. Data from participants who had not smoked at least 100 cigarettes over the course of their life were also excluded.
According to the CDC data, more men than women had emphysema, and more women had chronic bronchitis. Oddly enough, the data showed that of COPD patients, “almost half of them continued smoking” after diagnosis, he said. They were also more likely to be regular drinkers and less likely to exercise.
The raw numbers suggested that about one in four of the respondents who did not have COPD had CVD, but 56.5% with COPD did have CVD. Another interesting finding was that “being Hispanic and having a higher level of education were associated with lower risk” of CVD, even in the presence of COPD, Finklestein said. He told Medical Device Daily that the fact that there is no cure for COPD might explain the persistence of tobacco use in this population.
Veronica Sansing, a researcher at the Center for Minority Health at the University of Pittsburgh, discussed a study that examined how blacks and whites report their impressions of their general health and how closely those reports tracked clinical indices of health. For this study, Sansing and her co-authors looked at patients with Type 2 diabetes who had undergone coronary bypass and angioplasty to treat congestive heart disease.
Sansing said that it was not surprising that African Americans reported poorer health, but “what was surprising was how much more poorly African Americans reported their health.” She said that the phenomenon “carries over to other diseases,” but “there’s a lack of research into pessimism and diseases.”
Sansing reminded the audience that “risk factors for Type 2 diabetes and coronary artery disease (CAD) are more prevalent in blacks compared to non-Hispanic whites.
The study enrolled a total of 1,199 subjects. Of these, 333 were black and the balance of 866 was made up of whites of non-Hispanic ancestry. “Only black and white subjects were analyzed,” she said, citing unspecified problems with widening the study population.
“White patients were mainly male and had an average age of 64,” but “less than half of blacks were male,” Sansing said. Blacks were less likely to be married or to have finished high school, and whites were more likely to have a hypoglycemic episode while blacks were more likely to have chronic renal dysfunction. She also said of white patients that some factor correlated with self-reports of fair or poor health, such as education, but that this particular effect was not seen in blacks. However, diabetic neuropathy correlated to fair or poor self-reports for both groups.
Some potential confounders not examined in the study were dental health and psychosocial factors, both of which Sansing said were “shown to be highly correlated” with those with Type 2 diabetes. However, the analysis worked out most of the observed factors and the conclusion was that “health pessimism was more common in black patients than white patients,” and that under these circumstances, self-reported health was less predictive of clinical health.
Sansing told Medical Device Daily that the medical literature does include data on depression as distributed across racial groups, and that depression “has been found to impact” self-reported health status.