Blacks, Whites, and Risk of Sudden Cardiac Arrest

Study Questions:

What are the clinical profile differences between whites and blacks who experience sudden cardiac arrest (SCA)?

Methods:

The authors queried the Oregon Sudden Unexpected Death Study (Oregon SUDS), which is an ongoing, prospective, multiple-source, population-based examination of SCA. Patient demographics, arrest circumstances, pre-SCA clinical profile, and incidence rates were compared by race.

Results:

Age-adjusted rates of SCA were two-fold higher among black men and women (175 and 90 per 100,000, respectively), compared to white men and women (84 and 40 per 100,000, respectively). Compared to whites, blacks were >6 years younger at the time of SCA and had a higher pre-arrest prevalence of diabetes, hypertension, and chronic renal insufficiency. There were no racial differences in previously documented coronary artery disease (CAD) or left ventricular dysfunction, but blacks had more prevalent congestive heart failure, left ventricular hypertrophy, and a longer QT interval (QTc).

Conclusions:

The authors concluded that blacks had a much higher risk of SCA than whites. This may be due to the fact that blacks had a higher prevalence of risk factors beyond established CAD.

Perspective:

Disparities in cardiovascular disease and cardiovascular mortality between blacks and whites in the United States are well corroborated. This study focuses on SCA differences between whites and blacks, for which there are much fewer data. Diabetes, hypertension, left ventricular hypertrophy, heart failure, and chronic kidney disease are more prevalent among blacks than whites, which may explain the increased risk of SCA in this population. Genetic variation or other yet unidentified factors may also contribute to the overall risk for SCA in this vulnerable population. Nota bene, this study honed in on the differences between whites and blacks, as there were very few subjects among other minority ethnic groups. Future studies should address this limitation. Additionally, future research should examine which focused interventions among blacks are most effective to address the increased risk for SCA.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: African Americans, Coronary Artery Disease, Death, Sudden, Cardiac, Diabetes Mellitus, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Ventricular Dysfunction, Left


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