Young BA et al. (2006) Racial and ethnic differences in incident myocardial infarction in end-stage renal disease patients: the USRDS. Kidney Int 69: 1691–1698

Among patients with chronic renal insufficiency, cardiovascular disease (CVD) risk is higher in racial and ethnic minorities than in whites. Young et al. have investigated whether there are ethnic differences in incident myocardial infarction (MI) rates among patients with end-stage renal disease (ESRD).

The analysis included 271,102 patients who initiated renal replacement therapy in the US between January 1995 and December 2000, and were eligible for Medicare insurance coverage. Prevalent CVD was present in 43.8% of patients. Overall, 52.1% of participants were white, 31.6% were African American, 3.0% were Asian American and 11.5% were Hispanic.

Prevalent CVD was most common in whites (60.0% of all CVD cases), followed by African Americans (25.6%), Hispanics (10.1%), Asian Americans (2.57%) and other ethnicities (1.69%). Unadjusted MI event rates were approximately twice as high in patients with prevalent CVD than in those without CVD. Factors associated with higher nonfatal and combined (i.e. fatal and nonfatal) MI rates among patients with and without CVD were white race, increasing age, and inability to walk. Among patients with prevalent CVD, whites had the highest risk of combined MI; risk was 35% lower in African Americans, 26% lower in Asian Americans, and 28% lower in Hispanics, after adjustment for confounding factors. Whites also showed the greatest risk of combined MI among patients without prevalent CVD.

The authors conclude that incident MI risk is higher in ESRD patients with prevalent CVD than in those without, and that MI risk among ESRD patients is higher in whites than in other ethnic groups.