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

Study Questions:

Are there disparities in the incidence of coronary events among black and white patients in the contemporary era?

Methods:

The authors assessed the incident coronary heart disease (CHD) among 24,443 participants who were free of CHD at baseline and were enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, and resided in the continental United States. The study participants were enrolled between 2003 and 2007, with follow-up through December 31, 2009. The outcome measures were adjudicated by an expert panel and included total (fatal and nonfatal) CHD, fatal CHD, and nonfatal CHD (definite or probable myocardial infarction). Very small non–ST-segment elevation myocardial infarction (NSTEMI) was defined as peak troponin level <0.5 μg/L.

Results:

The mean follow-up was 4.2 years. There were 659 incident CHD events. Among men, the age-standardized incidence rate per 1,000 person-years for total CHD was 9.0 for blacks versus 8.1 for whites; fatal CHD: 4.0 versus 1.9; and nonfatal CHD: 4.9 versus 6.2. Among women, the age-standardized incidence rate per 1,000 person-years for total CHD was 5.0 for blacks versus 3.4 for whites; fatal CHD: 2.0 versus 1.0, respectively; and nonfatal CHD: 2.8 versus 2.2. Age- and region-adjusted hazard ratios for fatal CHD among blacks versus whites was approximately 2.0 for both men and women, but became statistically nonsignificant after multivariable adjustment. The multivariable-adjusted hazard ratio for incident nonfatal CHD for blacks versus whites was 0.68 (95% confidence interval [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:

A higher risk of fatal CHD events was observed among blacks compared with whites, and was associated partly with risk factor burden.

Perspective:

Racial differences in coronary artery disease prevalence and care processes have been reported in the past. This study demonstrated a higher incidence of fatal CHD in blacks compared with whites, whereas the nonfatal CHD events were more common in whites. Further, the difference between blacks and whites was attenuated after adjustment for CHD risk factors, renal function, inflammatory markers, and socioeconomic factors, suggesting that part of the racial disparity could be accounted for by risk factors, and thus be potentially modifiable. There is an ongoing need to focus on optimization of primary risk factor control to reduce the risk of CHD in all racial groups.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Coronary Artery Disease, Myocardial Infarction, Stroke, Socioeconomic Factors, Risk Factors, United States, Troponin


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