Association of race and sex with risk of incident acute coronary heart disease events.

CONTEXT It is unknown whether long-standing disparities in incidence of coronary heart disease (CHD) among US blacks and whites persist. OBJECTIVE To examine incident CHD by black and white race and by sex. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 24,443 participants without CHD at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, who resided in the continental United States and were enrolled between 2003 and 2007 with follow-up through December 31, 2009. MAIN OUTCOME MEASURE Expert-adjudicated total (fatal and nonfatal) CHD, fatal CHD, and nonfatal CHD (definite or probable myocardial infarction [MI]; very small non-ST-elevation MI [NSTEMI] had peak troponin level <0.5 μg/L). RESULTS Over a mean (SD) of 4.2 (1.5) years of follow-up, 659 incident CHD events occurred (153 in black men, 138 in black women, 254 in white men, and 114 in white women). Among men, the age-standardized incidence rate per 1000 person-years for total CHD was 9.0 (95% CI, 7.5-10.8) for blacks vs 8.1 (95% CI, 6.9-9.4) for whites; fatal CHD: 4.0 (95% CI, 2.9-5.3) vs 1.9 (95% CI, 1.4-2.6), respectively; and nonfatal CHD: 4.9 (95% CI, 3.8-6.2) vs 6.2 (95% CI, 5.2-7.4). Among women, the age-standardized incidence rate per 1000 person-years for total CHD was 5.0 (95% CI, 4.2-6.1) for blacks vs 3.4 (95% CI, 2.8-4.2) for whites; fatal CHD: 2.0 (95% CI, 1.5-2.7) vs 1.0 (95% CI, 0.7-1.5), respectively; and nonfatal CHD: 2.8 (95% CI, 2.2-3.7) vs 2.2 (95% CI, 1.7-2.9). Age- and region-adjusted hazard ratios for fatal CHD among blacks vs whites was near 2.0 for both men and women and became statistically nonsignificant after multivariable adjustment. The multivariable-adjusted hazard ratio for incident nonfatal CHD for blacks vs whites was 0.68 (95% 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 The higher risk of fatal CHD among blacks compared with whites was associated with cardiovascular disease risk factor burden. These relationships may differ by sex.

[1]  Fred S Apple,et al.  Third universal definition of myocardial infarction , 2012 .

[2]  A. Folsom,et al.  Twenty-Two–Year Trends in Incidence of Myocardial Infarction, Coronary Heart Disease Mortality, and Case Fatality in 4 US Communities, 1987–2008 , 2012, Circulation.

[3]  D. Newby,et al.  Implications of lowering threshold of plasma troponin concentration in diagnosis of myocardial infarction: cohort study , 2012, BMJ : British Medical Journal.

[4]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2012 update: a report from the American Heart Association. , 2012, Circulation.

[5]  T. Rea,et al.  Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease , 2011, Heart.

[6]  Daniel Polsky,et al.  Coronary revascularization trends in the United States, 2001-2008. , 2011, JAMA.

[7]  D. Newby,et al.  Implementation of a sensitive troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. , 2011, JAMA.

[8]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2011 update: a report from the American Heart Association. , 2011, Circulation.

[9]  Alan S. Go,et al.  Population trends in the incidence and outcomes of acute myocardial infarction. , 2010, The New England journal of medicine.

[10]  S. Normand,et al.  Recent Declines in Hospitalizations for Acute Myocardial Infarction for Medicare Fee-for-Service Beneficiaries: Progress and Continuing Challenges , 2010, Circulation.

[11]  V. Howard,et al.  Prevalence of hypertension by duration and age at exposure to the stroke belt. , 2010, Journal of the American Society of Hypertension : JASH.

[12]  Ronald J. Prineas,et al.  The Minnesota Code Manual of Electrocardiographic Findings , 2009 .

[13]  C. Schmid,et al.  A new equation to estimate glomerular filtration rate. , 2009, Annals of internal medicine.

[14]  L. Newby,et al.  Use of Guidelines-Recommended Management and Outcomes Among Women and Men With Low-Level Troponin Elevation: Insights From CRUSADE , 2009, Circulation. Cardiovascular quality and outcomes.

[15]  B. Gersh Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention , 2009 .

[16]  S. Windecker,et al.  Impact of changing definitions for myocardial infarction: a report from the AMIS registry. , 2008, The American journal of medicine.

[17]  J. Alpert,et al.  Diagnostic application of the universal definition of myocardial infarction in the intensive care unit , 2008, Current opinion in critical care.

[18]  K. Reynolds,et al.  Trends in Statin Use and Low-Density Lipoprotein Cholesterol Levels Among US Adults: Impact of the 2001 National Cholesterol Education Program Guidelines , 2008, The Annals of pharmacotherapy.

[19]  F. Neumann,et al.  New definition of myocardial infarction: impact on long-term mortality. , 2008, The American journal of medicine.

[20]  J. Alpert,et al.  Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction , 2008 .

[21]  Jeroen J. Bax,et al.  Universal definition of myocardial infarction. , 2007 .

[22]  A. Folsom,et al.  Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects--Atherosclerosis Risk in Communities Study. , 2007, Archives of internal medicine.

[23]  J. Birkmeyer,et al.  Opening of specialty cardiac hospitals and use of coronary revascularization in medicare beneficiaries. , 2007, Journal of the American Medical Association (JAMA).

[24]  H. Krumholz,et al.  Certificate of Need Regulation and Cardiac Catheterization Appropriateness After Acute Myocardial Infarction , 2007, Circulation.

[25]  F. L. Lucas,et al.  Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001 , 2006, Circulation.

[26]  C. Moy,et al.  The Reasons for Geographic and Racial Differences in Stroke Study: Objectives and Design , 2005, Neuroepidemiology.

[27]  E. Fisher,et al.  Racial Trends in the Use of Major Procedures among the Elderly , 2005 .

[28]  G. Mensah Eliminating Disparities in Cardiovascular Health: Six Strategic Imperatives and a Framework for Action , 2005, Circulation.

[29]  Ali H. Mokdad,et al.  State of Disparities in Cardiovascular Health in the United States , 2005, Circulation.

[30]  Randall C. Thompson,et al.  Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention , 2004, Circulation.

[31]  Daniel W. Jones,et al.  Risk factors for coronary heart disease in African Americans: the atherosclerosis risk in communities study, 1987-1997. , 2002, Archives of internal medicine.

[32]  George A. Mensah,et al.  Sudden Cardiac Death in the United States, 1989 to 1998 , 2001, Circulation.

[33]  A. Crook,et al.  Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization. , 2001, The New England journal of medicine.

[34]  R. Virmani,et al.  Sudden cardiac death. , 1987, Human pathology.

[35]  Daniel Levy,et al.  Accuracy of Death Certificates for Coding Coronary Heart Disease as the Cause of Death , 1998, Annals of Internal Medicine.

[36]  R. Califf,et al.  Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? , 1997, The New England journal of medicine.

[37]  D Wybenga,et al.  Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. , 1996, The New England journal of medicine.

[38]  D. Rubin Multiple Imputation After 18+ Years , 1996 .

[39]  D B Rubin,et al.  Multiple imputation in health-care databases: an overview and some applications. , 1991, Statistics in medicine.

[40]  A. Marty Minnesota Code Manual of Electrocardiographic Findings , 1983 .

[41]  Ronald J. Prineas,et al.  The Minnesota code manual of electrocardiographic findings : standards and procedures for measurement and classification , 1982 .

[42]  J J Heger,et al.  Sudden cardiac death. , 1998, Circulation.