Differences in Sudden Cardiac Death Risk Between Blacks and Whites

Nov 13, 2018
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Authors:
Deo R, Safford MM, Khodneva YA, et al.
Citation:
Differences in Risk of Sudden Cardiac Death Between Blacks and Whites. J Am Coll Cardiol 2018;72:2431-2439.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

Are racial differences in sudden cardiac death (SCD) incidence attributable to differences in the prevalence of risk factors or to underlying susceptibility to fatal arrhythmias?

Methods:

This was an analysis of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, which is a prospective, population-based cohort of adults in the United States.

Results:

There were 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease. During the follow-up of 6.1 years, there were 174 SCD events (67 whites and 107 blacks). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI], 1.4-2.2) compared with whites (0.7; 95% CI, 0.6-0.9). The association of black race with SCD risk remained significant after adjustment for socio-demographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality.

Conclusions:

In a large prospectively followed population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences persisted after adjustment for demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.

Perspective:

The study confirms the consistent finding that blacks suffer from SCD at rates about twice as high as whites, but it differs from prior studies in that unlike prior studies, patients with known cardiovascular disease were excluded from analysis. Unlike in prior studies, the differences in SCD rates were not fully explained by differences in the socioeconomic measures, behavioral patterns, and comorbidities, suggesting that there may be racial or genetic causes resulting in higher SCD rates among blacks. It is not clear whether this finding is a result of noncaptured cofactors or a true underlying predisposition.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: African Americans, Arrhythmias, Cardiac, Comorbidity, Death, Sudden, Cardiac, Heart Failure, Primary Prevention, Risk Factors, Socioeconomic Factors, Stroke


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