Perspective:

The following are five key points from this review of the relative prevalence of atrial fibrillation (AF) in blacks:

1. Several studies have reported a two- to three-fold higher prevalence of AF in whites than blacks.

2. Because traditional risk factors for AF such as hypertension and diabetes are more common in blacks, the lower prevalence of AF in blacks than whites has been termed the ‘AF paradox.’

3. There is no evidence that the apparently lower prevalence of AF in blacks is due to racial differences in the detection or reporting of AF.

4. There is also no evidence that the lower prevalence of AF in blacks is due to survival bias, since several studies have shown a consistently lower incidence of AF in blacks even when adjusted for age.

5. It is possible that there are racial differences in the prevalence of genetic factors (i.e., mutations or single nucleotide polymorphisms) that predispose to AF, but this remains to be determined.