Relationships among race, bleeding, and mortality in coronary reperfusion.

There are several examples of therapies that have differential effects in specific racially or ethnically distinct subgroups of the US population. For example, persons of African heritage generally have a poorer blood pressure response to angiotensin-converting enzyme inhibitors and -blockers in comparison with whites, but they derive greater benefit in the prevention of heart failure from the combination of isosorbide dinitrate and hydralazine. Indeed, this latter finding led to the first drug approved to treat a disease in patients identified by race. The explanations for racial and ethnic differences in response may be related to genetic factors that determine drug exposure (ie, differences in absorption, distribution, metabolism, and elimination), intrinsic factors (eg, age, sex, weight, renal and/or hepatic function), extrinsic influences (eg, diet, concomitant medications and nontraditional therapies, environmental exposure, and cultural factors), or a combination therein.