Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis

Abstract

Purpose We studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited. Methods We excluded participants with a history of AF at enrollment. A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases, Ninth Revision, codes. Age- and sex-adjusted incidence rates (IRs) of AF were calculated per 1000 person-years of observation. IR ratios were calculated using NHWs as the reference group. Age- and sex-adjusted population attributable fractions (PAFs) of established modifiable AF risk factors were ascertained. Results In the MESA cohort, 47.2% was male; at baseline, 25.7% had hypertension; 12.5% had diabetes. Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years. Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics, NHBs and Chinese compared with NHWs (all P < .001). Among participants 65 years of age or greater, Hispanics, Chinese, and blacks had significantly lower AF incidence than NHWs (all P ≥ 01), but IRs were similar among participants under age 65 years. The PAF for smoking was 27% among NHBs but lower among other race–ethnic groups. Among NHWs, the PAF for hypertension was 22.2%, but this was higher among NHBs (33.1%), Chinese (46.3%), and Hispanics (43.9%). Conclusions Overall, the incidence of hospitalized AF was significantly lower in Hispanics, NHBs, and Chinese than in NHWs. A larger proportion of AF events appear to be attributable to hypertension among nonwhite populations compared with NHWs.

Prediction of Atrial Fibrillation in a Racially Diverse Cohort: The Multi‐Ethnic Study of Atherosclerosis (MESA)

“…Comparing the calibration of the CHARGE‐AF and Framingham AF models suggests that models for AF prediction need to incorporate race/ethnicity as an important covariate. This is consistent with the growing evidence pointing to a higher risk of AF in whites compared to nonwhites 10, 11, 21, 33. Moreover, not surprisingly, we demonstrate that use of scores for risk stratification of ischemic stroke in patients with AF, such as CHADS 2 and CHA 2 DS 2 ‐VASc, are not adequate for AF prediction.…”

“…Whether the model would adequately predict AF in more racially and ethnically diverse populations is not known. This is particularly relevant given the observed lower risk of AF in nonwhites (including Hispanics and Asian Americans) compared to whites 10, 11. Therefore, we assessed the predictive ability (discrimination and calibration) of the CHARGE‐AF risk model in the Multi‐Ethnic Study of Atherosclerosis (MESA), a community‐based, racially and ethnically diverse prospective cohort in the United States.…”

Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status

“…8 The same results have been found in different cohorts. [22][23][24][25][26][27][28] Complementing previous studies, we now show that AAs have lower lifetime risk of AF than whites, despite higher prevalence of AF risk factors. However, notwithstanding their lower lifetime risk, still 1 in 5 AAs in ARIC were estimated to develop AF during their lifetime, certainly not a trivial figure.…”

“…5 However, the recent Framingham estimates, though taking into account recent upward trends in the incidence of AF, 7 may not be generalizable to nonwhite populations because its participants are from a predominantly white population of European origin. Because African Americans and other ethnic and racial groups have lower risk of AF compared with whites, 8,9 contemporary estimates of lifetime risk of AF in more diverse populations are needed.…”

Early Hemodynamic Changes during Head-Up Tilt Table Testing Can Predict a Neurocardiogenic Response in an African-American Patient Population

“…BP control in African Americans is significantly worse in patients with chronic kidney disease than Caucasians [29]. There are racial differences in the incidence of atrial fibrillation with an overall decreased incidence in African Americans compared with Caucasians [30]. Twin family studies involving same-gender mono- and dizygotic twins suggest a strong genetic component in the pathophysiology of vasovagal syncope [31].…”