Association of Race and Sex with Risk of Incident Acute Coronary Heart Disease Events

Abstract

CONTEXT-It is unknown whether long-standing disparities in incidence of coronary heart disease (CHD) among US blacks and whites persist.Corresponding Author: Monika M. Safford, MD, University of Alabama School of Medicine, 1717 11 th Avenue South, MT643, Birmingham, msafford@uab Author Contributions: Dr Safford had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Safford, Muntner, Durant, Lewis, Cushman, V. Howard. Acquisition of data: Safford, Prineas, Samdarshi, Lewis, V. Howard, G. Howard. Analysis and interpretation of data: Safford, Brown, Muntner, Durant, Glasser, Halanych, Shikany, Bittner, Gamboa, Cushman, G. RESULTS-Over a mean (SD) of 4.2 (1.5) years of follow-up, 659 incident CHD events occurred (153 in black men, 138 in black women, 254 in white men, and 114 in white women). Among men, the age-standardized incidence rate per 1000 person-years for total CHD was 9.0 (95% CI, 7.5-10.8) for blacks vs 8.1 (95% CI, 6.9-9.4) for whites; fatal CHD: 4.0 (95% CI, 2.9-5.3) vs 1.9 (95% CI, 1.4-2.6), respectively; and nonfatal CHD: 4.9 (95% CI, 3.8-6.2) vs 6.2 (95% CI, 5.2-7.4). Among women, the age-standardized incidence rate per 1000 person-years for total CHD was 5.0 (95% CI, 4.2-6.1) for blacks vs 3.4 (95% CI, 2.8-4.2) for whites; fatal CHD: 2.0 (95% CI, 1.5-2.7) vs 1.0 (95% CI, 0.7-1.5), respectively; and nonfatal CHD: 2.8 (95% CI, 2.2-3.7) vs 2.2 (95% CI, 1.7-2.9). Age-and region-adjusted hazard ratios for fatal CHD among blacks vs whites was near 2.0 for both men and women and became statistically nonsignificant after multivariable adjustment. The multivariable-adjusted hazard ratio for incident nonfatal CHD for blacks vs whites was 0.68 (95% CI, 0.51-0.91) for men and 0.81 (95% CI, 0.58-1.15) for women. Of the 444 nonfatal CHD events, 139 participants (31.3%) had very small NSTEMIs.CONCLUSIONS-The higher risk of fatal CHD among blacks compared with whites was associated with cardiovascular disease risk factor burden. These relationships may differ by sex.

Cardiovascular Risk Factors in Younger Black Women: Results from the 10,000 Women Community Screening Project

“…There are sex and ethnic disparities in CVD and associated risk factor diagnosis, management, response to treatment, and overall outcomes [1] , [2] , [3] . Specifically, CVD affects black women more than other groups [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] . According to the 2020 Heart Disease and Stroke Statistics update, 57.1% of black women have CVD compared to 43.4% of white, 42.6% of hispanic, and 37.2% of asian women [1] .…”

“…Furthermore, the uneven distribution of CVD among racial groups within the female population begins early, as black women develop CVD earlier in life [7] . The higher prevalence and earlier onset of heart disease among black females translates to increased heart disease-associated morbidity and mortality within this group compared to other female groups [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] .…”