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Black-White Differences in Incident Fatal, Nonfatal, and Total Coronary Heart Disease.
Pubmed ID: 28696265
Pubmed Central ID: PMC5551431
Journal: Circulation
Publication Date: July 11, 2017
Affiliation: From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.). mms9024@med.cornell.edu.
MeSH Terms: Humans, Male, Female, Aged, Risk Factors, Age Factors, Middle Aged, Coronary Disease, Sex Factors, Follow-Up Studies, Incidence, Databases, Factual, Black People, White People
Grants: P30 DK079626, R01 HL080477, U01 NS041588, K24 HL111154
Authors: Howard G, Levitan EB, Safford MM, Soliman EZ, Colantonio LD, Gamboa CM, Richman JS
Cite As: Colantonio LD, Gamboa CM, Richman JS, Levitan EB, Soliman EZ, Howard G, Safford MM. Black-White Differences in Incident Fatal, Nonfatal, and Total Coronary Heart Disease. Circulation 2017 Jul 11;136(2):152-166.
Studies:
Abstract
BACKGROUND: Blacks have higher coronary heart disease (CHD) mortality compared with whites. However, a previous study suggests that nonfatal CHD risk may be lower for black versus white men. METHODS: We compared fatal and nonfatal CHD incidence and CHD case-fatality among blacks and whites in the Atherosclerosis Risk in Communities study (ARIC), the Cardiovascular Health Study (CHS), and the Reasons for Geographic and Racial Differences in Stroke study (REGARDS) by sex. Participants 45 to 64 years of age in ARIC (men=6479, women=8488) and REGARDS (men=5296, women=7822), and ≥65 years of age in CHS (men=1836, women=2790) and REGARDS (men=3381, women=4112), all without a history of CHD, were analyzed. Fatal and nonfatal CHD incidence was assessed from baseline (ARIC=1987-1989, CHS=1989-1990, REGARDS=2003-2007) through up to 11 years of follow-up. RESULTS: Age-adjusted hazard ratios comparing black versus white men 45 to 64 years of age in ARIC and REGARDS were 2.09 (95% confidence interval, 1.42-3.06) and 2.11 (1.32-3.38), respectively, for fatal CHD, and 0.82 (0.64-1.05) and 0.94 (0.69-1.28), respectively, for nonfatal CHD. After adjustment for social determinants of health and cardiovascular risk factors, hazard ratios in ARIC and REGARDS were 1.19 (95% confidence interval, 0.74-1.92) and 1.09 (0.62-1.93), respectively, for fatal CHD, and 0.64 (0.47-0.86) and 0.67 (0.48-0.95), respectively, for nonfatal CHD. Similar patterns were present among men ≥65 years of age in CHS and REGARDS. Among women 45 to 64 years of age in ARIC and REGARDS, age-adjusted hazard ratios comparing blacks versus whites were 2.61 (95% confidence interval, 1.57-4.34) and 1.79 (1.06-3.03), respectively, for fatal CHD, and 1.47 (1.13-1.91) and 1.29 (0.91-1.83), respectively, for nonfatal CHD. After multivariable adjustment, hazard ratios in ARIC and REGARDS were 0.67 (95% confidence interval, 0.36-1.24) and 1.00 (0.54-1.85), respectively, for fatal CHD, and 0.70 (0.51-0.97) and 0.70 (0.46-1.06), respectively, for nonfatal CHD. Racial differences in CHD incidence were attenuated among older women. CHD case fatality was higher among black versus white men and women, and the difference remained similar after multivariable adjustment. CONCLUSIONS: After accounting for social determinants of health and risk factors, black men and women have similar risk for fatal CHD compared with white men and women, respectively. However, the risk for nonfatal CHD is consistently lower for black versus white men and women.