Cardiology Section, Whitaker Cardiovascular Institute, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts2currently with the Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center Hea.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
JAMA Cardiol. 2016 Jul 1;1(4):433-41. doi: 10.1001/jamacardio.2016.1025.
The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation.
To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort.
DESIGN, SETTING, AND PARTICIPANTS: The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011-2013) with active surveillance for vital status and hospitalizations. Race was determined by self-report and categorized as white, black, or other.
Atrial fibrillation (adjudicated using electrocardiograms, hospital discharge codes, and death certificates), stroke, heart failure, CHD, and mortality.
After exclusions, 15 080 participants (mean [SD] age, 54.2 [5.8] years; 8290 women [55.5%]; 3831 black individuals [25.4%]) were included in this analysis. During a mean (SD) follow-up of 20.6 (6.2) years, there were 2348 cases of incident AF. The incident rates of AF per 1000 person-years were 8.1 (95% CI, 7.7-8.5) in white individuals and 5.8 (95% CI, 5.2-6.3) in black individuals. The rates of stroke, heart failure, CHD, and mortality were higher in black individuals with AF than white individuals with AF. The association of AF with these outcomes, estimated with rate differences (rate of the end point in those with AF minus the rate in those without AF per 1000 person-years), also differed by race. The rate difference for stroke in individuals with AF was 10.2 (95% CI, 6.6-13.9) in white individuals and 21.4 (95% CI, 10.2-32.6) in black individuals. For heart failure and CHD, the rate differences were 1.5- to 2.0-fold higher in black individuals than white individuals. White individuals with AF had a rate difference of 55.9 (95% CI, 48.1-63.7) for mortality compared with black individuals, who had a rate difference of 106.0 (95% CI, 86.0-125.9).
In the prospective ARIC Study, the outcome of AF on the rates of stroke, heart failure, CHD, and mortality was considerably larger in black individuals than white individuals. These results indicate the vulnerability and increased risk in black individuals with AF. Continued investigation of racial differences in AF and its related adverse outcomes are essential to identify and mitigate racial disparities in the treatment of AF.
与心房颤动（AF）相关的不良结局已在主要为白人的队列中进行了研究。AF 相关结局的种族差异值得进一步研究。
在一个基于社区的队列中评估 AF 与中风、心力衰竭、冠心病（CHD）和全因死亡率的种族特异性关联。
设计、地点和参与者：动脉粥样硬化风险社区（ARIC）研究是一项前瞻性、观察性队列研究。在 1987 年至 1989 年期间，ARIC 研究纳入了 15792 名男性和女性，并进行了 4 次随访检查（2011-2013 年），对生命状态和住院情况进行了积极监测。种族通过自我报告确定，并分为白人、黑人或其他。
心房颤动（通过心电图、医院出院代码和死亡证明判定）、中风、心力衰竭、CHD 和死亡率。
排除后，共有 15080 名参与者（平均[标准差]年龄 54.2[5.8]岁；8290 名女性[55.5%]；3831 名黑人个体[25.4%]）纳入本分析。在平均[标准差]随访 20.6[6.2]年后，有 2348 例新发 AF。白人个体中每 1000 人年的新发 AF 发生率为 8.1（95%CI，7.7-8.5），黑人个体中为 5.8（95%CI，5.2-6.3）。与白人 AF 患者相比，黑人 AF 患者的中风、心力衰竭、CHD 和死亡率更高。通过率差异（AF 患者终点的发生率减去无 AF 患者的发生率，每 1000 人年）估计的 AF 与这些结局的关联也因种族而异。AF 患者中风的率差异在白人个体中为 10.2（95%CI，6.6-13.9），在黑人个体中为 21.4（95%CI，10.2-32.6）。对于心力衰竭和 CHD，黑人个体的率差异是白人个体的 1.5 至 2.0 倍。与黑人个体相比，AF 患者的死亡率差异为 55.9（95%CI，48.1-63.7），而黑人个体的死亡率差异为 106.0（95%CI，86.0-125.9）。
在前瞻性 ARIC 研究中，与白人个体相比，黑人个体中 AF 对中风、心力衰竭、CHD 和死亡率的影响要大得多。这些结果表明，黑人 AF 患者的脆弱性和风险增加。进一步研究 AF 及其相关不良结局的种族差异，对于识别和减轻 AF 治疗中的种族差异至关重要。
