Racial Differences in Atrial Fibrillation Prevalence and Left Atrial Size

Marcus, Gregory M.; Olgin, Jeffrey E.; Whooley, Mary A.; Vittinghoff, Eric; Stone, Katie L.; Mehra, Reena; Hulley, Stephen B.; Schiller, Nelson B.

doi:10.1016/j.amjmed.2009.05.019

Cited by 88 publications

(79 citation statements)

References 30 publications

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“…These findings are consistent with the results of several prior studies that found lower rates of AF in black compared with white patients 3, 4, 5, 6, 7, 8, 9, 10, 11. These studies involved analysis of administrative claims data in all patients presenting for acute care,3 prospective ascertainment of AF based on periodic ECG screening and hospitalization records,4, 5, 6, 7, 8 or examination of electronic medical records to identify clinical diagnoses of AF or ECGs showing AF 9, 10.…”

Section: Discussionsupporting

confidence: 93%

“…Conversely, studies consistently report that black patients have lower rates of atrial fibrillation (AF)—one of the strongest risk factors for stroke2—than white patients 3, 4, 5, 6, 7, 8, 9, 10, 11. It is unclear whether the lower reported rate of AF in black persons represents a truly lower burden of AF or more frequent underdiagnosis of this often paroxysmal dysrhythmia in black persons 12, 13.…”

Section: Introductionmentioning

confidence: 99%

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Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

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BackgroundBlack US residents experience higher rates of ischemic stroke than white residents but have lower rates of clinically apparent atrial fibrillation (AF), a strong risk factor for stroke. It is unclear whether black persons truly have less AF or simply more undiagnosed AF.Methods and ResultsWe obtained administrative claims data from state health agencies regarding all emergency department visits and hospitalizations in California, Florida, and New York. We identified a cohort of patients with pacemakers, the regular interrogation of which reduces the likelihood of undiagnosed AF. We compared rates of documented AF or atrial flutter at follow‐up visits using Kaplan–Meier survival statistics and Cox proportional hazards models adjusted for demographic characteristics and vascular risk factors. We identified 10 393 black and 91 380 white patients without documented AF or atrial flutter before or at the index visit for pacemaker implantation. During 3.7 (±1.8) years of follow‐up, black patients had a significantly lower rate of AF (21.4%; 95% CI 19.8–23.2) than white patients (25.5%; 95% CI 24.9–26.0). After adjustment for demographic characteristics and comorbidities, black patients had a lower hazard of AF (hazard ratio 0.91; 95% CI 0.86–0.96), a higher hazard of atrial flutter (hazard ratio 1.29; 95% CI 1.11–1.49), and a lower hazard of the composite of AF or atrial flutter (hazard ratio 0.94; 95% CI 0.88–99).ConclusionsIn a population‐based sample of patients with pacemakers, black patients had a lower rate of AF compared with white patients. These findings indicate that the persistent racial disparities in rates of ischemic stroke are likely to be related to factors other than undiagnosed AF.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

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“…48 Clinical study suggested that a higher AF rate in Caucasians than in African-Americans might be related to a larger LA diameter. 49 Regardless of the elevated AF risk from aging, African-Americans had a 41% lower age-and sex-adjusted risk of being diagnosed with AF compared with Whites. 50 Moreover, another clinical study revealed that systemic inflammatory biomarkers such as adiponectin, tumor necrosis factor (TNF)-α, TNF-α SR I, and TNF-α SR II concentrations were each higher among Whites and independently associated with a greater risk of incident AF, 51 which suggests systemic inflammatory pathways significantly mediate the heightened risk of AF among Whites.…”

Section: Racial and Sex Influences On Aging-related Afmentioning

confidence: 97%

Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation

Lin

Chen

Lee

et al. 2018

Circ J

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how aging and AF are connected and highlight the potential role of aging in AF substrate and triggered remodeling. Effects of Aging on Structural RemodelingStructural remodeling is characterized by histopathological changes, such as cellular hypertrophy, apoptosis, or myocardial fibrosis, and anatomical changes, such as chamber dilatation. 5 Anatomical Changes With Dilation of PV and Atria in AgingThe left atrium (LA) anteroposterior diameter and wall thickness increase with aging, and the 4 PVs become dilated in patients older than 50 years (Figure 1), 3 which suggests mechanical effects of aging on AF triggers and substrates. 3 Clinical data indicate that PV size correlates with PV arrhythmogenesis. Therefore, larger PVs may correlate with a higher PV arrhythmogenesis resulting in AF. Histopathological Changes With AgingBoth animal and human studies had shown that loss of cardiomyocytes by apoptosis and necrosis produces compensatory cellular hypertrophy, which may represent the structural basis of the aged heart, and contribute to cardiac dysfunction in the elderly. 5 Aging increases the rate of ventricular cardiomyocyte death caused by enhanced vulnerability to stress such as oxidative stress. 6 These histopathological changes at the microscopic level potentially T he prevalence and severity of arrhythmias increase with age. Advancing age is independently associated with the prevalence of atrial fibrillation (AF). 1 Aging and aging-related underlying diseases frequently result in structural remodeling as cardiac morphological changes either grossly or at the histological and ultrastructural levels, or they induce electrophysiological remodeling with changes in cardiac electrical properties in response to a functional insult, or as a result of a structural alteration. Aging-associated cardiac anatomical and functional remodeling may enhance the occurrence or the persistence of AF.Ectopic impulses generated from the pulmonary veins (PVs) play a key role in the genesis and maintenances of AF. 2 Elimination of PV arrhythmogenic foci or targeting atrial substrate abnormalities reduces the AF burden or cures AF. 2 PVs contain complex electrical activity because of their distinctive anatomical and physiological characteristics. 3 Aging-associated electrophysiological or structural changes in the atria or PVs may facilitate AF occurrence. 3 Age is an independent predictor of AF recurrence in lone AF patients after undergoing the first circumferential PV isolation. 4 AF may coexist with cardiovascular disorders, which may potentiate its occurrence, and these are also more prevalent with increased age. Together with agingrelated myocardial degeneration or anatomical changes, both inflammation and oxidative stress, as consequences of aging, enhance the occurrence and maintenance of AF. The aim of this review is to update the understanding of Aging plays a critical role in the genesis of atrial fibrillation (AF) and also increases the risks of cardiac dysfunction and stroke in AF patients. AF is caused by increased AF t...

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“…Examination of AF incidence in relation to race in the Atherosclerosis Risk in Communities (ARIC) study 19,21 demonstrated significantly lower rates of new AF in black men and women than in white men and women, despite the higher risk profile in black participants and that the rates of new AF in blacks were lower when examined in subjects with optimal, borderline, or elevated risk factors for AF. 19 Black participants aged ≥ 65 years in the Cardiovascular Health Study had a 45% lower risk of incident AF after adjusting for age, sex, and other risk factors, 24 were significantly less likely to have incident or prevalent AF in a pooled analysis of data from three cohort studies, 23 and had significantly lower prevalence of AF in >18,000 participants in the Reasons for Geographic and Racial Differences in Stroke study. 20 The risk of AF in blacks is also significantly attenuated among heart failure patients 25 and after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, traditional risk factors appear to have similar strengths of association with new AF in blacks and whites, despite the lower risk of AF in blacks. 21,22 The lower risk of AF in blacks has been potentially attributed in part to possible racial differences in left atrial size, 23 cardiac autonomic tone, 27 the sensitivity of methods used to detect AF, 20 and underascertainment of AF in blacks, 21 possibly because of potential differences in access to care. Recent work has also suggested that the lower risk of AF in blacks may be in part attributable to genetic factors, with an increased estimated degree of European ancestry in blacks associated with an increased risk of incident AF.…”

Section: Original Articlementioning

confidence: 99%

Racial Differences in Incident Atrial Fibrillation Among Hypertensive Patients During Antihypertensive Therapy

Okin

Bang

Wachtell

et al. 2014

American Journal of Hypertension

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Atrial fibrillation (AF) is a common arrhythmia 1,2 that is increasing in prevalence. 2 The incidence of AF increases with age 1 and is increased in patients with heart failure, left ventricular hypertrophy (LVH), and coronary heart disease and is particularly strongly related to hypertension. [3][4][5][6][7][8][9][10][11][12] The increased risk of death, 3-5 sudden cardiac death, 6 heart failure, 5 and stroke 3,7,8 in patients with AF and the significant risks associated with antiarrhythmic and antithrombotic therapies aimed at preventing AF recurrences and decreasing the risk of embolic sequella [13][14][15] highlight the importance of preventing AF and the need to better understand the epidemiologic risk factors that may predispose to AF. 16,17 Racial or ethnic differences in the prevalence and incidence of AF are of significant importance. Blacks appear to have a lower risk of incident and prevalent AF in the general population, 1,11,18-24 among heart failure patients, 25 and after cardiac surgery, 26 despite a greater burden of traditional AF risk factors. Indeed, traditional risk factors appear to have similar strengths of association with new AF in blacks and whites, despite the lower risk of AF in blacks. 21,22 The lower risk of AF in blacks has been potentially attributed in part to possible racial differences in left atrial size, 23 cardiac autonomic tone, 27 the sensitivity of methods used to detect AF, 20 and underascertainment of AF in blacks, 21 possibly because of potential differences in access to care. Recent work has also suggested that the lower risk of AF in blacks may be in part attributable to genetic factors, with an increased estimated degree of European ancestry in blacks associated with an increased risk of incident AF. 28 Hypertensive patients with LVH are at a particularly high risk of AF. 2,3,5,11,12,29 background Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined.

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Racial Differences in Atrial Fibrillation Prevalence and Left Atrial Size

Cited by 88 publications

References 30 publications

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Aging Modulates the Substrate and Triggers Remodeling in Atrial Fibrillation

Racial Differences in Incident Atrial Fibrillation Among Hypertensive Patients During Antihypertensive Therapy

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