Alpert Medical School of Brown University, Director, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860, USA.
Circulation. 2012 Aug 7;126(6):688-96. doi: 10.1161/CIRCULATIONAHA.111.066688. Epub 2012 Jul 2.
The differences in the incidence of heart failure by race/ethnicity and the potential mechanisms for these differences are largely unexplored in women.
A total of 156 143 postmenopausal women free of self-reported heart failure enrolled from 1993 to 1998 at 40 clinical centers throughout the United States as part of the Women's Health Initiative and were followed up until 2005, for an average of 7.8 years, for incident hospitalized heart failure. Incident rates, hazard ratios (HRs), and 95% confidence intervals were determined by use of the Cox proportional hazard model comparing racial/ethnic groups, and population-attributable risk percentages were calculated for each racial/ethnic group. Blacks had the highest age-adjusted incidence of heart failure (380 in 100 000 person-years), followed by whites (274), Hispanics (193), and Asian/Pacific Islanders (103). The excess risk in blacks compared with whites (age-adjusted HR=1.45) was significantly attenuated by adjustment for household income (HR=0.97) and diabetes mellitus (HR=0.89), but the lower risk in Hispanics (age-adjusted HR=0.72) and Asian/Pacific Islanders (age-adjusted HR=0.44) remained despite adjustment for traditional risk factors, socioeconomic status, lifestyle, and access-to-care variables. The effect of adjustment for interim coronary heart disease on nonwhite versus white HRs for heart failure differed by race/ethnic group.
Asian/Pacific Islander and Hispanic women have a lower incidence of heart failure and black women have higher rates of heart failure compared with white women. The excess risk of incident heart failure in black women is explained largely by adjustment for lower household incomes and diabetes mellitus in black women, whereas the lower rates of heart failure in Asian/Pacific Islanders and Hispanics are largely unexplained by the risk factors measured in this study.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
种族/民族之间心力衰竭发生率的差异以及导致这些差异的潜在机制在女性中尚未得到充分探索。
共有 156143 名绝经后女性参加了该研究，她们于 1993 年至 1998 年期间在美国 40 个临床中心无自述心力衰竭病史，作为妇女健康倡议的一部分入组，随访至 2005 年，平均随访时间为 7.8 年，以确定新发住院心力衰竭事件。采用 Cox 比例风险模型比较种族/民族组，确定发病率、风险比（HR）和 95%置信区间，并计算每个种族/民族组的人群归因风险百分比。黑人的心力衰竭年龄调整发病率最高（380/100000 人年），其次是白人（274）、西班牙裔（193）和亚裔/太平洋岛民（103）。与白人相比，黑人的风险增加（年龄调整 HR=1.45），经家庭收入（HR=0.97）和糖尿病（HR=0.89）调整后显著减弱，但西班牙裔（年龄调整 HR=0.72）和亚裔/太平洋岛民（年龄调整 HR=0.44）的风险仍然较低，尽管调整了传统危险因素、社会经济地位、生活方式和获得医疗保健变量。调整中间冠心病对非白人与白人心力衰竭 HR 的影响因种族/民族而异。
与白人女性相比，亚裔/太平洋岛民和西班牙裔女性心力衰竭的发病率较低，而黑人女性心力衰竭的发生率较高。黑人女性新发心力衰竭风险的增加主要归因于黑人女性较低的家庭收入和糖尿病的调整，而亚裔/太平洋岛民和西班牙裔女性心力衰竭发生率较低在很大程度上不能用本研究中测量的危险因素来解释。
