University of North Carolina at Chapel Hill, Chapel Hill, NC.
Wake Forest University School of Medicine, Winston Salem, NC.
Am Heart J. 2019 Oct;216:1-8. doi: 10.1016/j.ahj.2019.06.017. Epub 2019 Jul 3.
A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically.
We performed 48-hour ambulatory electrocardiography (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse.
African Americans were more likely than Whites to have hypertension and diabetes but less likely to have coronary heart disease. The prevalence of AF detected by aECG or ARIC study ECG (adjusted for age and coronary heart disease) was lower in African Americans than Whites (2.7% vs 5.0%). White men had a higher (although not significant) AF prevalence of 7.8% compared to the other race and gender groups at 2.3%-2.8%. The adjusted OR for AF was 0.49 (0.24-0.99) comparing African Americans to Whites. Findings were similar when AF was defined to include prior AF hospitalizations (OR = 0.42, 0.25-0.72). There were no significant differences by race for asymptomatic or paroxysmal AF.
Atrial fibrillation was less prevalent in African American than white older adults, regardless of detection method. Although overall detection of new AF cases with aECG was low, future studies should consider longer-term monitoring to characterize AF by race.
在通过大多采用 12 导联心电图（ECG）和临床检查识别的 AF 研究中，与白人相比，非裔美国人的 AF 患病率较低，但心血管疾病危险因素的负担却更高。
我们对动脉粥样硬化风险社区（ARIC）研究中的 1193 名双种族参与者（平均年龄 78 岁，62%为非裔美国人，64%为女性）进行了 48 小时动态心电图（aECG）检查。从 aECG、研究访视 ECG 和队列住院的出院代码中确定 AF。我们使用协变量调整的逻辑回归来估计非裔美国人相对于白人的 AF 患病率比值比（OR），并对抽样和无应答进行了调整。
与白人相比，非裔美国人更有可能患有高血压和糖尿病，但更不可能患有冠心病。通过 aECG 或 ARIC 研究 ECG（按年龄和冠心病调整）检测到的 AF 患病率在非裔美国人中低于白人（2.7%比 5.0%）。白人男性的 AF 患病率（尽管没有统计学意义）较高，为 7.8%，而其他种族和性别组的 AF 患病率为 2.3%-2.8%。非裔美国人相对于白人的 AF 调整 OR 为 0.49（0.24-0.99）。当 AF 定义为包括既往 AF 住院时，发现的结果相似（OR=0.42，0.25-0.72）。非裔美国人和白人之间在无症状或阵发性 AF 方面没有显著差异。
无论检测方法如何，非裔美国老年人的 AF 患病率均低于白人老年人。虽然使用 aECG 对新发 AF 病例的整体检出率较低，但未来的研究应考虑进行更长时间的监测，以确定种族与 AF 的关系。
