Bahrami Hossein, Kronmal Richard, Bluemke David A, Olson Jean, Shea Steven, Liu Kiang, Burke Gregory L, Lima João A C
Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD 21287, USA.
Arch Intern Med. 2008 Oct 27;168(19):2138-45. doi: 10.1001/archinte.168.19.2138.
The relationship between incident congestive heart failure (CHF) and ethnicity as well as racial/ethnic differences in the mechanisms leading to CHF have not been demonstrated in a multiracial, population-based study. Our objective was to evaluate the relationship between race/ethnicity and incident CHF.
The Multi-Ethnic Study of Atherosclerosis (MESA) is a cohort study of 6814 participants of 4 ethnicities: white (38.5%), African American (27.8%), Hispanic (21.9%), and Chinese American (11.8%). Participants with a history of cardiovascular disease at baseline were excluded. Cox proportional hazards models were used for data analysis.
During a median follow-up of 4.0 years, 79 participants developed CHF (incidence rate: 3.1 per 1000 person-years). African Americans had the highest incidence rate of CHF, followed by Hispanic, white, and Chinese American participants (incidence rates: 4.6, 3.5, 2.4, and 1.0 per 1000 person-years, respectively). Although risk of developing CHF was higher among African American compared with white participants (hazard ratio, 1.8; 95% confidence interval, 1.1-3.1), adding hypertension and/or diabetes mellitus to models including ethnicity eliminated statistical ethnic differences in incident CHF. Moreover, African Americans had the highest proportion of incident CHF not preceded by clinical myocardial infarction (75%) compared with other ethnic groups (P = .06).
The higher risk of incident CHF among African Americans was related to differences in the prevalence of hypertension and diabetes mellitus as well as socioeconomic status. The mechanisms of CHF also differed by ethnicity; interim myocardial infarction had the least influence among African Americans, and left ventricular mass increase had the greatest effect among Hispanic and white participants.
在一项基于人群的多民族研究中，尚未证实新发充血性心力衰竭（CHF）与种族以及导致CHF的机制中的种族差异之间的关系。我们的目的是评估种族与新发CHF之间的关系。
动脉粥样硬化多民族研究（MESA）是一项队列研究，有来自4个种族的6814名参与者：白人（38.5%）、非裔美国人（27.8%）、西班牙裔（21.9%）和美籍华人（11.8%）。基线时有心血管疾病史的参与者被排除。采用Cox比例风险模型进行数据分析。
在中位随访4.0年期间，79名参与者发生了CHF（发病率：每1000人年3.1例）。非裔美国人的CHF发病率最高，其次是西班牙裔、白人和美籍华人参与者（发病率分别为每1000人年4.6例、3.5例、2.4例和1.0例）。尽管与白人参与者相比，非裔美国人发生CHF的风险更高（风险比，1.8；95%置信区间，1.1 - 3.1），但在包含种族的模型中加入高血压和/或糖尿病后，新发CHF的种族统计学差异消失。此外，与其他种族相比，非裔美国人发生CHF且无临床心肌梗死病史的比例最高（75%）（P = 0.06）。
非裔美国人新发CHF风险较高与高血压、糖尿病患病率以及社会经济地位的差异有关。CHF的机制也因种族而异；心肌梗死对非裔美国人的影响最小，而左心室质量增加对西班牙裔和白人参与者的影响最大。
