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Atrial fibrillation is the most frequent sustained cardiac arrhythmia in clinical practice. The estimated prevalence in the US is more than two million individuals. Most epidemiology data is based on whites, but reports suggest that AF is lower among African Americans despite higher prevalence of risk factors for AF, such as hypertension and obesity. What is the incidence and cumulative risk of AF in African-Americans compared to whites?
The researchers evaluated 15792 participants in the Atherosclerosis Risk in Communities (ARIC) study. The study followed 4 communities around the US with a large number of African-Americans enrolled. Dr. Alvaro Alonso of the University of Minnesota, Minneapolis, MN was the lead author.
Through subject followed between 1987 and 2004, the diagnosis of AF was made either by ECG, hospital discharge records, or death certificates. Results showed the incidence of AF increased exponentially with age in all groups. It was higher in men compared to women, and whites compared to African-Americans. The estimated cumulative risk of AF at 80 years of age is twice as high in white men as in African-Americans. Although the burden of AF in African-Americans is lower than whites it is substantial with 1 in 9 diagnosed before age 80. This data was consistent with previous evidence showing lower incidence and prevalence of AF in African-Americans.
AF risk factors such as hypertension are higher in African-Americans than whites as seen in ARIC and prior studies. These traditional AF risk factors may not play the same role in development of AF in African-Americans. The authors examined many possible mechanisms for the lower burden of AF in African-Americans, but were unable to explain the discrepancy.
Evaluation of the data did not lead to a better understanding of the reasons for the 50% lower cumulative risk of AF among African Americans. The authors recommend “future studies comparing risk factors for AF in whites and African-Americans are needed to provide insights into the mechanisms explaining the racial discrepancy” (Alonso et al. Incidence of atrial fibrillation in whites and African-Americans: The Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2009; 158: 111-117)
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