Advertisement

Relative contribution of modifiable risk factors for incident atrial fibrillation in Hispanics, African Americans and non-Hispanic Whites

Published:October 09, 2018DOI:https://doi.org/10.1016/j.ijcard.2018.10.028

      Highlights

      • Relative contribution of factors for the association of atrial fibrillation (AF) in minority populations is poorly understood
      • 47,722 individuals were followed for incident AF
      • Hypertension in African Americans and Hispanics had greater population attributable risks compared with non-Hispanics Whites.
      • Similar findings existed for the presence of heart failure, with higher attributable risks in non-Whites compared to Whites

      Abstract

      Background

      Contribution of modifiable risk factors for the risk of new onset atrial fibrillation (AF) in minority populations is poorly understood. Our objective was to compare the population attributable risk (PAR) of various risk factors for incident AF between Hispanic, African American and non-Hispanic Whites.

      Methods

      An ECG/EMR database was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. Cox regression analysis controlled for age > 65, male gender, body mass index > 40 kg/m2, systolic blood pressure > 140 mm Hg, diabetes mellitus, heart failure, socioeconomic status less than the first percentile in New York State, and race/ethnicity. PAR was calculated as (prevalence of X) ∗ (HR − 1)/HR, where HR is the hazard ratio, and X is the risk factor.

      Results

      47,722 persons free of AF (43% Hispanic, 37% Black and 20% White) were followed for subsequent incident AF. Hypertension in African Americans and Hispanics had a 7.93% and 7.66% greater PAR compared with non-Hispanics Whites. Similar findings existed for the presence of heart failure, with a higher PAR in non-Whites compared to Whites.

      Conclusion

      In conclusion, modifiable risk factors play an important role in the risk of incident AF. Higher PAR estimates in African Americans and Hispanics were observed for elevated systolic blood pressure and heart failure. Identification of these modifiable risk factors for atrial fibrillation in non-White minorities may assist in targeting better prevention therapies and planning from a public health perspective. No funding sources were used for this study.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Odutayo A.
        • Wong C.X.
        • Hsiao A.J.
        • Hopewell S.
        • Altman D.G.
        • Emdin C.A.
        Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.
        BMJ. 2016; 354i4482
        • Kim M.H.
        • Johnston S.S.
        • Chu B.C.
        • Dalal M.R.
        • Schulman K.L.
        Estimation of total incremental health care costs in patients with atrial fibrillation in the United States.
        Circ. Cardiovasc. Qual. Outcomes. 2011; 4: 313-320
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • Chang Y.
        • Henault L.E.
        • Selby J.V.
        • Singer D.E.
        Prevalence of diagnosed atrial fibrillation in adults.
        JAMA. 2001; 285: 6
        • Hong K.L.
        • Glover B.M.
        The impact of lifestyle intervention on atrial fibrillation.
        Curr. Opin. Cardiol. 2018; 33: 14-19
        • Schnabel R.B.
        Can we predict the occurrence of atrial fibrillation?.
        Clin. Cardiol. 2012; 35: 5
        • Schnabel R.B.
        • Aspelund T.
        • Li G.
        • Sullivan L.M.
        • Suchy-Dicey A.
        • Harris T.B.
        • Pencina M.J.
        • D'Agostino R.B.
        • Levy D.
        • Kannel W.B.
        • Wang T.J.
        • Krommal R.A.
        • Wolf P.A.
        • Burke G.L.
        • Launer L.J.
        • Vasan R.S.
        • Psaty B.M.
        • Benjamin E.J.
        • Gudnason V.
        • Heckbert S.R.
        Validation of an atrial fibrillation risk algorithm in whites and African Americans.
        Arch. Intern. Med. 2010; 170: 9
        • Wang L.
        • Southerland J.
        • Wang K.
        • Bailey B.A.
        • Alamian A.
        • Stevens M.A.
        • Wang Y.
        Ethnic differences in risk factors for obesity among adults in California, the United States.
        J. Obes. 2017; 2017: 2427483
        • Shulman E.
        • Kargoli F.
        • Aagaard P.
        • Hoch E.
        • Di Biase L.
        • Fisher J.
        • Gross J.
        • Kim S.
        • Ferrick K.J.
        • Krumerman A.
        Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic whites.
        Clin. Cardiol. 2017; 40: 770-776
        • Shulman E.
        • Kargoli F.
        • Aagaard P.
        • Hoch E.
        • Di Biase L.
        • Fisher J.
        • Gross J.
        • Kim S.
        • Krumerman A.
        • Ferrick K.J.
        Validation of the Framingham heart study and CHARGE-AF risk scores for atrial fibrillation in Hispanics, African-Americans, and non-Hispanic whites.
        Am. J. Cardiol. 2016; 117: 76-83
        • Jensen P.N.
        • Thacker E.L.
        • Dublin S.
        • Psaty B.M.
        • Heckbert S.R.
        Racial differences in the incidence of and risk factors for atrial fibrillation in older adults: the cardiovascular health study.
        J. Am. Geriatr. Soc. 2013; 61: 276-280
      1. Facts Q. US Census Bureau, 2013 (Retrieved Jan 2013)
        • IEC IS
        Particular Requirements for Safety, Including Essential Performance, of Recording and Analyzing Single Channel and Multichannel Electrocardiographs.
        2003
        • Bogun F.
        • Anh D.
        • Kalahasty G.
        • Wissner E.
        • Bou Serhal C.
        • Bazzi R.
        • Weaver W.D.
        • Schuger C.
        Misdiagnosis of atrial fibrillation and its clinical consequences.
        Am. J. Med. 2004; 117: 636-642
        • Guglin M.E.
        • Thatai D.
        Common errors in computer electrocardiogram interpretation.
        Int. J. Cardiol. 2006; 106: 232-237
        • Poon K.
        • Okin P.M.
        • Kligfield P.
        Diagnostic performance of a computer-based ECG rhythm algorithm.
        J. Electrocardiol. 2005; 38: 235-238
        • Hajat A.
        • Diez-Roux A.V.
        • Adar S.D.
        • Auchincloss A.H.
        • Lovasi G.S.
        • O'Neill M.S.
        • Sheppard L.
        • Kaufman J.D.
        Air pollution and individual and neighborhood socioeconomic status: evidence from the Multi-Ethnic Study of Atherosclerosis (MESA).
        Environ. Health Perspect. 2013; 121: 1325-1333
        • Alonso A.
        • Agarwal S.K.
        • Soliman E.Z.
        • Ambrose M.
        • Chamberlain A.M.
        • Prineas R.J.
        • Folsom A.R.
        Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study.
        Am. Heart J. 2009; 158: 111-117
        • Dewland T.A.
        • Olgin J.E.
        • Vittinghoff E.
        • Marcus G.M.
        Incident atrial fibrillation among Asians, Hispanics, blacks, and whites.
        Circulation. 2013; 128: 2470-2477
        • Cutler J.A.
        • Sorlie P.D.
        • Wolz M.
        • Thom T.
        • Fields L.E.
        • Roccella E.J.
        Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004.
        Hypertension. 2008; 52: 818-827
        • Rodriguez C.J.
        • Soliman E.Z.
        • Alonso A.
        • Swett K.
        • Okin P.M.
        • Goff Jr., D.C.
        • Heckbert S.R.
        Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the multi-ethnic study of atherosclerosis.
        Ann. Epidemiol. 2015; 25 (76 e71): 71-76
        • O'Neal W.T.
        • Judd S.E.
        • Limdi N.A.
        • McIntyre W.F.
        • Kleindorfer D.O.
        • Cushman M.
        • Howard V.J.
        • Howard G.
        • Soliman E.Z.
        Differential impact of risk factors in blacks and whites in the development of atrial fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.
        J. Racial Ethn. Health Disparities. 2017; 4: 718-724
        • Hajjar I.
        • Kotchen T.A.
        Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000.
        JAMA. 2003; 290: 199-206
        • Still C.H.
        • Craven T.E.
        • Freedman B.I.
        • Van Buren P.N.
        • Sink K.M.
        • Killeen A.A.
        • Bates J.T.
        • Bee A.
        • Contreras G.
        • Oparil S.
        • Pedley C.M.
        • Wall B.M.
        • White S.
        • Woods D.M.
        • Rodriguez C.J.
        • Wright Jr., J.T.
        • Group SSR
        Baseline characteristics of African Americans in the systolic blood pressure intervention trial.
        J. Am. Soc. Hypertens. 2015; 9: 670-679
        • Alexander M.
        • Grumbach K.
        • Selby J.
        • Brown A.F.
        • Washington E.
        Hospitalization for congestive heart failure. Explaining racial differences.
        JAMA. 1995; 274: 1037-1042
        • Bahrami H.
        • Kronmal R.
        • Bluemke D.A.
        • Olson J.
        • Shea S.
        • Liu K.
        • Burke G.L.
        • Lima J.A.
        Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis.
        Arch. Intern. Med. 2008; 168: 2138-2145
        • van Rooij E.
        • Sutherland L.B.
        • Qi X.
        • Richardson J.A.
        • Hill J.
        • Olson E.N.
        Control of stress-dependent cardiac growth and gene expression by a microRNA.
        Science. 2007; 316: 575-579
        • Small K.M.
        • Wagoner L.E.
        • Levin A.M.
        • Kardia S.L.
        • Liggett S.B.
        Synergistic polymorphisms of beta1- and alpha2C-adrenergic receptors and the risk of congestive heart failure.
        N. Engl. J. Med. 2002; 347: 1135-1142
        • Schnabel R.B.
        • Aspelund T.
        • Li G.
        Validation of an atrial fibrillation risk algorithm in whites and African Americans.
        Arch. Intern. Med. 2010; 170: 9
        • Wang T.J.
        • Parise H.
        • Levy D.
        • D'Agostino Sr., R.B.
        • Wolf P.A.
        • Vasan R.S.
        • Benjamin E.J.
        Obesity and the risk of new-onset atrial fibrillation.
        JAMA. 2004; 292: 2471-2477
        • Gami A.S.
        • Hodge D.O.
        • Herges R.M.
        • Olson E.J.
        • Nykodym J.
        • Kara T.
        • Somers V.K.
        Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation.
        J. Am. Coll. Cardiol. 2007; 49: 565-571
        • Shulman E.
        • Chudow J.J.
        • Shah T.
        • Shah K.
        • Peleg A.
        • Nevelev D.
        • Kargoli F.
        • Zaremski L.
        • Berardi C.
        • Natale A.
        • Romero J.
        • Di Biase L.
        • Fisher J.
        • Krumerman A.
        • Ferrick K.J.
        Relation of body mass index to development of atrial fibrillation in Hispanics, blacks, and non-Hispanic whites.
        Am. J. Cardiol. 2018; 121: 1177-1181
        • Thanassoulis G.
        • Massaro J.M.
        • O'Donnell C.J.
        • Hoffmann U.
        • Levy D.
        • Ellinor P.T.
        • Wang T.J.
        • Schnabel R.B.
        • Vasan R.S.
        • Fox C.S.
        • Benjamin E.J.
        Pericardial fat is associated with prevalent atrial fibrillation: the Framingham heart study.
        Circ. Arrhythm. Electrophysiol. 2010; 3: 345-350
        • Cossrow N.
        • Falkner B.
        Race/ethnic issues in obesity and obesity-related comorbidities.
        J. Clin. Endocrinol. Metab. 2004; 89: 2590-2594
        • Huxley R.R.
        • Lopez F.L.
        • Folsom A.R.
        • Agarwal S.K.
        • Loehr L.R.
        • Soliman E.Z.
        • Maclehose R.
        • Konety S.
        • Alonso A.
        Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study.
        Circulation. 2011; 123: 1501-1508
        • Jongnarangsin K.
        • Chugh A.
        • Good E.
        • Mukerji S.
        • Dey S.
        • Crawford T.
        • Sarrazin J.F.
        • Kuhne M.
        • Chalfoun N.
        • Wells D.
        • Boonyapisit W.
        • Pelosi Jr., F.
        • Bogun F.
        • Morady F.
        • Oral H.
        Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation.
        J. Cardiovasc. Electrophysiol. 2008; 19: 668-672
        • Conen D.
        • Tedrow U.B.
        • Koplan B.A.
        • Glynn R.J.
        • Buring J.E.
        • Albert C.M.
        Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women.
        Circulation. 2009; 119: 2146-2152
        • Tedrow U.B.
        • Conen D.
        • Ridker P.M.
        • Cook N.R.
        • Koplan B.A.
        • Manson J.E.
        • Buring J.E.
        • Albert C.M.
        The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study).
        J. Am. Coll. Cardiol. 2010; 55: 2319-2327
        • Pathak R.K.
        • Middeldorp M.E.
        • Lau D.H.
        • Mehta A.B.
        • Mahajan R.
        • Twomey D.
        • Alasady M.
        • Hanley L.
        • Antic N.A.
        • McEvoy R.D.
        • Kalman J.M.
        • Abhayaratna W.P.
        • Sanders P.
        Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study.
        J. Am. Coll. Cardiol. 2014; 64: 2222-2231
        • Lau D.H.
        • Mackenzie L.
        • Kelly D.J.
        • Psaltis P.J.
        • Brooks A.G.
        • Worthington M.
        • Rajendram A.
        • Kelly D.R.
        • Zhang Y.
        • Kuklik P.
        • Nelson A.J.
        • Wong C.X.
        • Worthley S.G.
        • Rao M.
        • Faull R.J.
        • Edwards J.
        • Saint D.A.
        • Sanders P.
        Hypertension and atrial fibrillation: evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model.
        Heart Rhythm. 2010; 7: 1282-1290
        • Abed H.S.
        • Samuel C.S.
        • Lau D.H.
        • Kelly D.J.
        • Royce S.G.
        • Alasady M.
        • Mahajan R.
        • Kuklik P.
        • Zhang Y.
        • Brooks A.G.
        • Nelson A.J.
        • Worthley S.G.
        • Abhayaratna W.P.
        • Kalman J.M.
        • Wittert G.A.
        • Sanders P.
        Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation.
        Heart Rhythm. 2013; 10: 90-100