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Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

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Abstract

Background

Despite a higher prevalence of risk factors, atrial fibrillation (AF) is less prevalent in blacks than whites. To address this paradox, we examined racial differences in the magnitude of AF risk associated with common risk factors.

Methods

Participants (13,688; mean age = 63 ± 8.4 years; 56 % female; 37 % black) from the Reasons for Geographic And Racial Differences in Stroke study who were free of baseline AF were included. Incident AF was identified at a follow-up examination by electrocardiogram and self-reported medical history. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between risk factors and incident AF in blacks and whites, separately. Age- and sex-adjusted population attributable fractions (PAFs) of modifiable AF risk factors were computed.

Results

After median follow-up of 9.4 years, 997 (7.3 %) incident AF cases were detected. Black race was associated with a lower risk of AF (RR = 0.46, 95 % CI = 0.39, 0.53). Significant risk factors for AF were age, male sex, hypertension, obesity, and cardiovascular disease. A differential association was detected for smoking by race, with the association being stronger in blacks (RR = 1.41, 95 % CI = 1.07, 1.85) compared with whites (RR = 1.01, 95 % CI = 0.88, 1.16; P interaction = 0.030). The PAFs for hypertension (blacks = 27.4 %, whites = 19.4 %), obesity (blacks = 16.9 %, whites = 11.8 %), and smoking (blacks = 17.9 %, whites = 2.5 %) were higher for blacks than whites.

Conclusion

Modifiable risk factors are important in AF development among blacks despite a lower risk of the arrhythmia. Racial differences in the magnitude of the association of individual AF risk factors do not explain the AF paradox.

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Acknowledgments

The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org.

Funding

This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA, 30322, USA

    Wesley T. O’Neal

  2. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Suzanne E. Judd & George Howard

  3. Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    Nita A. Limdi

  4. Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada

    William F. McIntyre

  5. Department of Neurology, University of Cincinnati, Cincinnati, OH, USA

    Dawn O. Kleindorfer

  6. Department of Medicine, University of Vermont, Burlington, VT, USA

    Mary Cushman

  7. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Virginia J. Howard

  8. Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

  9. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

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  1. Wesley T. O’Neal
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  2. Suzanne E. Judd
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  7. Virginia J. Howard
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  8. George Howard
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Corresponding author

Correspondence to Wesley T. O’Neal.

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The authors declare no conflicts of interest in the writing of this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants included in the study.

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O’Neal, W.T., Judd, S.E., Limdi, N.A. et al. Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study. J. Racial and Ethnic Health Disparities 4, 718–724 (2017). https://doi.org/10.1007/s40615-016-0275-3

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  • DOI: https://doi.org/10.1007/s40615-016-0275-3

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