Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
J Am Coll Cardiol. 2018 Nov 13;72(20):2431-2439. doi: 10.1016/j.jacc.2018.08.2173.
Prior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data.
The purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias.
The Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed.
Among 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77).
In a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.
先前的研究一致表明，黑人发生心脏性猝死（SCD）的几率大约是白人的两倍；然而，这些分析缺乏个体层面的社会人口学、合并症和行为健康数据。
本研究旨在评估 SCD 发生率的种族差异是否归因于危险因素的流行率差异，还是归因于致命性心律失常的潜在易感性差异。
REasons for Geographic and Racial Differences in Stroke 研究是一项在美国各地进行的前瞻性、基于人群的成年人队列研究。根据美国国立心肺血液研究所的标准，评估种族与 SCD 的关系。
在 22507 名无临床心血管疾病史的参与者（9416 名黑人，13091 名白人）中，中位随访 6.1 年（四分位距：4.6 至 7.3 年）期间发生了 174 例 SCD 事件（67 例白人，107 例黑人）。黑人的 SCD 发生率（每 1000 人年）为 1.8（95%置信区间：1.4 至 2.2），高于白人的 0.7（95%置信区间：0.6 至 0.9），未经调整的风险比为 2.35（95%置信区间：1.74 至 3.20）。在调整社会人口统计学、合并症、健康行为措施、心血管事件干预和非 SCD 死亡率的竞争风险后，黑人种族与 SCD 风险的关联仍然显著（风险比：1.97；95%置信区间：1.39 至 2.77）。
在一个没有心血管疾病史的大型混合种族成年人人群中，黑人的 SCD 发生率明显高于白人。这些种族差异不能完全用人口统计学、不利的社会经济措施、心血管危险因素和健康行为措施来解释。
