For his part, Dr. Murray Mittleman, director of the cardiovascular epidemiology research unit with the Beth Israel Deaconess Medical Center, Harvard Medical School, suggested that it can be very difficult to tease out exactly what's going on.
"Certainly differences in incidence, treatment and prognosis across different groups by gender, race or income level has been a very important topic that's been investigated for a very long time," Mittleman said. "But as to whether it's a question of underlying biological differences, social differences or behavioral differences among both patients and providers, we really don't know the answer."
Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, agreed that the situation is "always very complex."
"There are certainly many other variables to consider," Zonszein said. "Cultural, social, access of care, medication adherence. For example, I deal with a large African American and Hispanic population, and you do see that there is less adherence to medications. So they often come to the hospital with more advanced disease. And if someone comes to the hospital with early gangrene, it's very different than if someone comes in with late gangrene. That makes a difference in terms of amputations."
On the other hand, he added, "It's also true that while stroke is much higher among African Americans than white patients, they actually have a much lower coronary 'burden,' despite having more classic risk factors like smoking or obesity."
For more on peripheral artery disease, visit the U.S. National Library of Medicine.
SOURCES: Tyler S. Durazzo, M.D., resident, Massachusetts General Hospital, formerly with the department of surgery, Yale University School of Medicin
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