Stroke rate higher in East Asian vs. white adults, regardless of relationship to AF
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Key takeaways:
- East Asian adults had a higher rate of stroke compared with white adults.
- The presence of atrial fibrillation raised stroke risk similarly in both groups.
In a comparison of two cohorts, the rate of stroke was higher in East Asian adults than in white adults, though atrial fibrillation influenced the stroke rate equally in both groups, researchers reported at Heart Rhythm 2023.
The researchers conducted a patient-level comparative analysis of East Asian participants from the Korean National Health Insurance Service – Health Screening cohort (n = 446,986; mean age, 56 years; 54% men) and white participants from the UK Biobank cohort (n = 403,240; mean age, 57 years; 46% men).
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“Contemporary guidelines require an integrated approach for the prevention and treatment of complications associated with atrial fibrillation. However, most of the evidence for this is based on studies conducted in mainstream Western populations; that is, white populations,” Boyoung Joung, MD, professor of cardiology and internal medicine at Yonsei University College of Medicine in Seoul, South Korea, told Healio. “Therefore, there are challenges in applying the guidelines’ recommendations to the daily practice for other ethnicities. A better understanding of race-specific AF characteristics will not only help with medical planning and resource allocation but also guide interventions to address and mitigate disparities. In addition, our team has a strong advantage in elucidating these racial differences, as we have base data for medical services for nearly 1 million individuals.”
The outcome of interest was ischemic or hemorrhagic stroke, whether related to AF or not. The mean follow-up in the East Asian cohort was 7.3 years. The mean follow-up in the white cohort was 11.7 years.
Among people without AF, the incidence rates of ischemic or hemorrhagic stroke were higher for East Asian adults than white adults (0.36 per 100 person-years vs. 0.1 per 100 person-years; P < .001) and the same was true for people with AF (1.92 per 100 person-years vs. 0.55 per 100 person-years; P < .001), according to the researchers.
“East Asians in Korea were found to have more cardiovascular risk factors such as hypertension, diabetes and hyperlipidemia than the white comparison group, even at younger ages,” Joung told Healio. “This is partly attributed to poorer adverse outcomes compared to whites, regardless of atrial fibrillation status. Of course, future considerations should also include the effects of confounding variables not adjusted for in this study, such as salt sensitivity, dietary habits and extreme weather conditions.”
The presence of AF raised the risk for stroke similarly in both groups (HR in East Asian cohort = 2.62; 95% CI, 2.38-2.87; HR in white cohort = 2.85; 95% CI, 2.6-3.13; P for interaction = .09), Joung and colleagues found.
“There seems to be a need for thorough screening and early treatment for poorly controlled comorbidities in East Asians,” Joung told Healio. “Furthermore, the results of this study did not provide a clear answer as to whether these differences are truly due to race or due to acquired changes such as lifestyle habits. Therefore, we believe that utilizing patient-level data on East Asians living in Western societies could provide insights into this, and we are currently conducting an analysis on this.”
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Kang D, et al. Abstract PO-01-137. Presented at: Heart Rhythm 2023; May 19-21, 2023; New Orleans (hybrid meeting).
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