Rodriguez Fatima, Stefanick Marcia L, Greenland Philip, Soliman Elsayed Z, Manson JoAnn E, Parikh Nisha, Martin Lisa W, Larson Joseph C, Hlatky Mark, Nassir Rami, Cené Crystal W, Rodriguez Beatriz L, Albert Christine, Perez Marco V
Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA.
Am Heart J. 2016 Jun;176:70-7. doi: 10.1016/j.ahj.2016.03.004. Epub 2016 Mar 17.
The incidence of atrial fibrillation (AF) is higher in non-Hispanic whites (NHWs) compared with other race-ethnic groups, despite more favorable cardiovascular risk profiles. To explore reasons for this paradox, we compared the hazards of AF from traditional and other risk factors between 4 race-ethnic groups in a large cohort of postmenopausal women.
We included 114,083 NHWs, 11,876 African Americans, 5,174 Hispanics, and 3,803 Asians from the Women's Health Initiative free of AF at baseline. Women, averaging 63 years old, were followed up for incident AF using hospitalization records and diagnostic codes from Medicare claims.
Over a mean of 13.7 years, 19,712 incident cases of AF were recorded. Despite a higher burden of hypertension, diabetes, and obesity, annual AF incidence was lower among nonwhites (0.7%, 0.4%, and 0.4% for African American, Hispanic, and Asian participants, respectively, compared with 1.2% for NHWs). The hazards of AF from hypertension, diabetes, obesity, heart failure, and coronary artery disease were similar across race-ethnic groups. Major risk factors, including hypertension, obesity, diabetes, smoking, peripheral arterial disease, coronary artery disease, and heart failure, accounted for an attributable risk of 50.3% in NHWs, 83.1% in African Americans, 65.6% in Hispanics, and 37.4% in Asians. Established AF prediction models performed comparably across race-ethnic groups.
In this large study of postmenopausal women, traditional cardiovascular risk factors conferred a similar degree of individual risk of AF among 4 race-ethnic groups. However, major AF risk factors conferred a higher-attributable risk in African Americans and Hispanics compared with NHWs and Asians.
尽管非西班牙裔白人（NHW）的心血管风险状况更为有利，但与其他种族/族裔群体相比，其房颤（AF）发病率更高。为探究这一矛盾现象的原因，我们在一大群绝经后女性中比较了4个种族/族裔群体中传统及其他风险因素导致房颤的风险。
我们纳入了来自女性健康倡议（Women's Health Initiative）的114,083名基线时无房颤的非西班牙裔白人、11,876名非裔美国人、5,174名西班牙裔和3,803名亚裔女性。这些女性平均年龄为63岁，通过医疗保险理赔记录中的住院记录和诊断代码对房颤发病情况进行随访。
在平均13.7年的随访期内，共记录到19,712例房颤发病病例。尽管非白人中高血压、糖尿病和肥胖的负担更高，但非白人的房颤年发病率较低（非裔美国人、西班牙裔和亚裔参与者的发病率分别为0.7%、0.4%和0.4%，而非西班牙裔白人的发病率为1.2%）。种族/族裔群体之间，高血压、糖尿病、肥胖、心力衰竭和冠状动脉疾病导致房颤的风险相似。主要风险因素，包括高血压、肥胖、糖尿病、吸烟、外周动脉疾病、冠状动脉疾病和心力衰竭，在非西班牙裔白人中导致房颤的归因风险为50.3%，在非裔美国人中为83.1%，在西班牙裔中为65.6%，在亚裔中为37.4%。已建立的房颤预测模型在不同种族/族裔群体中的表现相当。
在这项针对绝经后女性的大型研究中，传统心血管风险因素在4个种族/族裔群体中导致房颤的个体风险程度相似。然而，与非西班牙裔白人和亚裔相比，主要房颤风险因素在非裔美国人和西班牙裔中导致的归因风险更高。
