Incidence of atrial fibrillation in whites and African-Americans: The Atherosclerosis Risk in Communities (ARIC) study

doi:10.1016/j.ahj.2009.05.010

American Heart Journal

Volume 158, Issue 1, July 2009, Pages 111-117

https://doi.org/10.1016/j.ahj.2009.05.010 Get rights and content

Objectives

To define the incidence and cumulative risk of atrial fibrillation (AF) in a population-based cohort of whites and African Americans.

Background

African-Americans reportedly have a lower risk of AF than whites despite their higher exposure to AF risk factors. However, precise estimates of AF incidence in African Americans have not been previously published.

Methods

We studied the incidence of AF in the Atherosclerosis Risk in Communities (ARIC) study, which has followed up 15,792 men and women 45 to 65 years of age at baseline from 4 communities in the United States since 1987. Atrial fibrillation cases were identified from electrocardiograms conducted at baseline and 3 follow-up visits, and from hospitalizations and death certificates through the end of 2004. During follow-up, 1,085 new cases of AF were identified (196 in African Americans, 889 in whites).

Results

Crude incidence rates of AF were 6.7, 4.0, 3.9, and 3.0 per 1,000 persons per year in white men, white women, African-American men, and African-American women, respectively. Increasing age was exponentially associated with an elevated risk of AF. Compared to whites, African-Americans had a 41% (95% CI: 8%-62%) lower age- and sex-adjusted risk of being diagnosed with AF. The cumulative risk of AF at 80 years of age was 21% in white men, 17% in white women, and 11% in African-American men and women.

Conclusion

In this population-based cohort, African Americans presented a lower risk of AF than whites. Still, the burden of AF among the former is substantial, with 1 in 9 receiving a diagnosis of AF before 80 years of age.

Section snippets

Study population

The Atherosclerosis Risk in Communities (ARIC) study is a population-based prospective study of cardiovascular disease in a cohort of 15,792 participants, 45 to 64 years of age at enrollment (55% women, 27% African American). Participants were sampled from 4 US communities (mostly whites from suburbs of Minneapolis, Minnesota, and Washington County, Maryland; African-Americans from Jackson, Mississippi; and whites and African-Americans from Forsyth County, North Carolina) during the period 1987

Results

Of 15,792 ARIC participants, 15,444 met eligibility criteria. At the baseline examination, 37 (0.2%) of them had AF in their ECG. Therefore, these individuals were excluded from the incidence calculations. Selected baseline characteristics of the study sample are shown in Table I. Prevalence of cardiovascular risk factors, such as hypertension, diabetes, left ventricular hypertrophy, body mass index, and smoking was higher in African-Americans than whites. From 1987 to 2004, during 228,976

Discussion

In this analysis of the ARIC cohort, we show that incidence of AF is higher in whites than in African-Americans despite risk factors for AF being more prevalent in the latter group. Incidence rates of AF among whites in the ARIC study were comparable to those obtained in other population-based studies conducted in the United States.4, 6, 7 Consistent with previous publications, AF rates increased exponentially with age and were higher in men than women. Finally, we estimated the cumulative risk

Acknowledgements

We thank the ARIC participants, staff, and investigators for their long-term contributions to ARIC.

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Clinical InvestigationElectrophysiologyIncidence of atrial fibrillation in whites and African-Americans: The Atherosclerosis Risk in Communities (ARIC) study

Objectives

Background

Methods

Results

Conclusion

Section snippets

Study population

Results

Discussion

Acknowledgements

Ann Emerg Med

Am J Cardiol

J Am Coll Cardiol

Ann Epidemiol

JAMA

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

Circulation

Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

Circulation

Prevalence of diagnosed atrial fibrillation in adults. National implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study

JAMA

Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence

Circulation

Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999. Implications for primary prevention

Circulation

Clinical Investigation
Electrophysiology
Incidence of atrial fibrillation in whites and African-Americans: The Atherosclerosis Risk in Communities (ARIC) study