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Black adults with AF show higher risk for stroke, HF, CHD than white adults
Although less likely to develop atrial fibrillation, black patients with the condition are at greater risk for stroke, HF, CHD and mortality than whites participants with AF, according to data published in JAMA Cardiology.
“We knew blacks were likely to have an increased risk of stroke, but the findings for HF, CHD and mortality are novel and important,” Jared W. Magnani, MD, associate professor of medicine, division of cardiology, University of Pittsburgh School of Medicine and cardiologist at UPMC Heart and Vascular Institute, said in a press release.
Jared W. Magnani
Magnani and colleagues evaluated the race-specific associations of AF with stroke, HF, CAD and mortality between white and black individuals enrolled in the ARIC study. Of the 15,080 participants included in the analysis, 55.5% were women and 25.4% were black. The black participants had higher BMI (mean, 29.6 kg/m2 vs. 27 kg/m2) and a higher prevalence of hypertension and diabetes. During a follow-up of approximately 20 years, 2,348 participants developed AF, with whites having a higher incidence rate than blacks (whites, 8.1 per 1,000 person-years; 95% CI, 7.7-8.5; blacks, 5.8 per 1,000 person-years; 95% CI, 5.2-6.3).
Outcomes worse in blacks
According to the results, the rate difference (defined as rate of those with AF minus the rate of those without AF per 1,000 person-years) for stroke in blacks with AF was 21.4 (95% CI, 10.2-32.6) vs. 10.2 (95% CI, 6.6-13.9) in whites with AF. In addition, the rate difference of HF and CHD in blacks was nearly double that of their white counterparts. The rate difference for mortality was 106 (95% CI, 86-125.9) for blacks vs. 55.9 (95% CI, 48.1-63.7) for whites.
“There needs to be further investigation,” Magnani said in the release. “It’s going to be important to dissect the mechanisms behind why blacks with [AF] are highly more likely to have adverse outcomes than whites.”
Magnani and colleagues called for current guidelines for managing AF by the American College of Cardiology, American Heart Association and Heart Rhythm Society to be updated to include the racial differences in adverse outcomes in patients.
No consistent genetic cause
In an accompanying editorial, Thomas D. Stamos, MD, and Dawood Darbar, MD, both of the division of cardiology at the University of Illinois at Chicago, wrote, “Magnani and colleagues importantly add to the literature another in the long list of studies showing [CV] disorders with either an increase in incidence or worse outcomes in black individuals compared with white individuals, including patients with [HF], stroke or [CAD].
“The reason for these disparities remains unclear,” Stamos and Darbar wrote. “Despite an intense search over the last decade, no consistent genetic cause has been identified. What is known is that there are a number of socioeconomic factors found more commonly among black individuals that strongly correlate with worse [CV] outcomes. There are many studies demonstrating the influence of neighborhood social environment and the risk of adverse health events. The possibility that these social determinants of health are playing a direct causative role through an epigenetic mechanism is an interesting, but still unproven theory.” – by Tracey Romero
Disclosure : The researchers, Darbar and Stamos report no relevant financial disclosures.