Secondary prevention after myocardial infarction widens health disparities between Swedish and immigrant patients

Background and introduction: Immigrants bear a disproportionate burden of poor cardiovascular health. Secondary prevention programs are essential for patients who have suffered from myocardial infarction (MI) as modification of risk factors favorably impacts their health. However, little is known about whether disparities in cardiovascular health are influenced by secondary prevention. Purpose: The purpose of this study was to determine if secondary prevention influences disparities in cardiovascular health between Swedish and immigrant MI patients. Methods: A cohort of 400 MI patients (58.6±8 years) was followed for two years, 292 Swedish and 108 immigrants (71% men). During the first year after MI patients participated in a secondary prevention program. The average number of six selected risk factors, before and two years post MI was evaluated and the mean change in risk burden from baseline calculated. The risk factors were current smoking, BMI >30 kg/m2, total cholesterol >4,5 or LDL >2,5 mmol/l (in accordance with reference values at the time of the study), HDL >1.0/1.2 (men/women) mmol/l, blood pressure >140/90 mmHg and HbA1c >45 mmol/mol (>52 mmol/mol for diabetic patients). Results: There were significant differences in risk factor exposure between Swedes and immigrants among men (p=0.045) and women (p=0.003) two years after MI. After adjustments for age, marital status and socio-economic status significance was lost among men. Swedish women reduced their exposure by 1.51 risk factors, while immigrant women only reduced theirs by 0.74 (p=0.007). No significant differences were observed for males, with Swedish men reducing their risk factors by 1.25 compared to 1.17 for immigrant men (p=0.593). Conclusion(s): The results indicate that while benefitting patients in general, secondary prevention did not benefit all groups equally. Immigrant women were less likely to reduce their risk than Swedish women, which could not be explained by age, marital status and socioeconomic status. No differences were found between immigrant and Swedish men