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Background— Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. Methods and Results— Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents aged 21 to 64 years hospitalized with a principal discharge diagnosis of ischemic heart disease before (November 1, 2004, to July 31, 2006) and after (December 1, 2006, to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted logistic regression assessed 24 216 discharges before reform and 20 721 discharges after reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the prereform period. Compared with whites in the postreform period, blacks (odds ratio=0.73; 95% confidence interval, 0.63–0.84) and Hispanics (odds ratio= 0.84; 95% confidence interval, 0.74–0.97) were less likely and Asians (odds ratio=1.29; 95% confidence interval, 1.01–1.65) were more likely to receive coronary revascularization. Patients living in more educated communities, men, and persons with private insurance were more likely to receive coronary revascularization before and after reform. Compared with the prereform period, the adjusted odds of in-hospital mortality were higher in patients living in less-educated communities in the postreform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed before or after reform. Conclusions— Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures.

Sickle cell disease (SCD) is an inheritable genetic disorder hallmarked by a single point mutation in the β-globin chain resulting in abnormal polymerization of deoxygenated hemoglobin and subsequent sickling of the erythrocyte. Longevity in SCD patients has greatly increased, shifting the paradigm for cause of death from acute to chronic conditions. Endothelial dysfunction attributed to SCD triggers a cascade of inflammatory biomarkers known to mediate several cardiovascular complications, however, the etiology of heart disease in SCD remains unclear. Cardiovascular manifestations resulting in premature mortality include elevated cardiac output, systolic and diastolic dysfunction, pulmonary hypertension, and sudden cardiac death. This review explores relevant biomarkers of inflammation typically observed as mediators or indicators of cardiovascular disease (CVD) as well as current literature on cardiovascular complications found in those with SCD. Additionally, the potential role of CVD treatments to manage the severity of SCD will be explored.