Perception of discrimination may bring worse heart attack outcomes

Experiencing discrimination has long been associated with risk factors for heart attacks. But new research suggests that perceptions of discrimination could also affect the health status of individuals following a heart attack.

In a study of more than 2,600 heart attack survivors, those who perceived more discrimination in their daily lives were at higher risk for worse outcomes than those who experienced little or no discrimination in the year following their heart attack. Perceived discrimination refers to the perception of being treated unfairly in day-to-day interactions because of personal characteristics, such as race, gender, ethnicity or socioeconomic status.

Results of the study were presented during the American Heart Association’s (AHA) Scientific Sessions 2022 in Chicago.

The authors arrived at their conclusions after analyzing data on post-heart attack health outcomes among participants in the “Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients” study. The outcomes they looked at included chest pain, physical limitations, patient-reported general physical and mental health status, treatment satisfaction and overall quality of life. Participants were between the ages of 18 and 55. About two-thirds were women and 76% self-identified as white, with the rest comprised of Black adults and “other.”

Participants were asked to complete three questionnaires at 1 month and 12 months post-heart attack to assess their level of perceived discrimination, heart attack recovery status—as measured by physical limitation and chest pain frequency—quality of life and general health status. In addition, they reported perceived discrimination of any type, general physical and mental health status, heart attack recovery status, treatment satisfaction and quality of life.

Analyses of the questionnaires scores and data revealed that:

• Over one-third of the participants reported experiencing discrimination in their everyday lives,
• higher exposure to perceived discrimination was primarily associated with worse heart attack recovery status (indicated by lower scores on the Seattle Angina Questionnaire, one of the tools used to measure patient satisfaction and quality of life),
• people with higher levels of perceived discrimination were more likely to report physical limitations and more frequent chest pain up to one year into the heart attack recovery period, and
• patients who reported higher levels of perceived discrimination also reported worse mental health status, treatment satisfaction and quality of life within the first year after their heart attack.

“Perceived discrimination acts as a chronic stressor that adversely impacts cardiovascular disease through increased stress levels and inflammation,” Andrew Arakaki, M.P.H. one of the study’s authors and a doctoral candidate in the department of chronic disease epidemiology at the Yale School of Public Health said in a press release. “Perceived discrimination is also associated with other psychosocial factors, such as low social support and distrust in the health care system, which may affect patients’ recovery after a heart attack.”

Arakaki said the research demonstrates the important role that perceived discrimination plays in determining heart attack-specific outcomes compared to the general/generic measures of physical and mental health status. He and the other authors cautioned that since the majority of the study’s participants were white and women, and the data analyses didn’t include those who didn’t complete the perceived discrimination questionnaire, the results may not be generalizable to the public.

Michelle A. Albert, M.D., M.P.H., president of the AHA, said the study shows that “Health care professionals need to really understand the impact of structural racism and structural discrimin

ation on health outcomes within this vein. That means that we need to double down on having culturally competent doctors and other health care professionals who understand the lived experiences of their patients, as well as who will listen to the concerns of their patients.”