Replacing ‘race’ as an underlying health condition would improve heart disease care, study suggests

BOSTON, Mass. — When doctors are treating patients at risk for heart disease, race is a factor in the care people receive. This isn’t necessarily about bias. Historically, researchers say Black patients have a higher risk of developing heart problems, leading to different treatment plans in comparison to white patients. Now, a new study suggests that replacing the term “race” as an underlying health risk may lead to more appropriate care for patients with the exact same symptoms — regardless of skin color.

“If other factors (instead of race itself) determine the risk differences, then the prediction equations should incorporate those factors that cause the differences in predicted risk between the races, rather than race itself. If we do not change our prediction strategy, there is a risk of labeling (stereotyping) Black people as high risk purely based on the color of their skin,” explains corresponding author Dr. Vasan Ramachandran from the Boston University School of Medicine in a media release.

What factors play into heart health care?

Researchers asked why two people, with the same risk level for heart attacks and strokes, receive different treatment depending on their race. Their study examined 50,000 different risk factor combinations for heart disease, using the American Heart Association/American College of Cardiology’s current system for predicting heart disease.

This equation looks at a person’s risk of having a heart attack or stroke within the next 10 years depending on several factors, including age, sex, race, blood pressure, cholesterol levels, diabetes, and smoking habits. However, in this model, Black and Caucasian individuals with the same readings actually have a different risk level for heart disease.

“In these situations when the predicted risks are so different, doctors may treat their Black and white patients differently even when they have identical risk factors purely because of their race,” says Ramachandran, who is also director of the Framingham Heart Study.

Results show 20 percent of the risk combinations among men and 22 percent among women lead to doctors prescribing different treatment programs for Black and white patients. In these cases, Black heart disease patients receive a prescription for statins more often than their white peers.

Is it something other than race?

Ramachandran believes doctors are missing what’s really causing these medical differences, increasing the risk of them treating the wrong factors that are contributing to a person’s heart issues.

“Since the equations are derived from historical cohort data, the Black-white differences in predicted risk probabilities may reflect underlying race-related differences in health care access, structural racism or social determinants of health,” the study author says.

“Furthermore, more research is needed to be able to determine if such causal prediction equations remain accurate after those at high risk are treated. In other words, we should investigate whether we can use the same prediction equations when risk factors are altered with interventions,” adds co-author Edwin van den Heuvel, adjunct professor of medicine at BUSM.

The findings appear in The Lancet Digital Health.