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

Carlos J. Rodriguez, Elsayed Z. Soliman, Alvaro Alonso, Katrina Swett, Peter M. Okin, David C. Goff, Susan R. Heckbert

Research output: Contribution to journalArticlepeer-review

76 Scopus citations

Abstract

Purpose: We studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited. Methods: We excluded participants with a history of AF at enrollment. A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases, Ninth Revision, codes. Age- and sex-adjusted incidence rates (IRs) of AF were calculated per 1000 person-years of observation. IR ratios were calculated using NHWs as the reference group. Age- and sex-adjusted population attributable fractions (PAFs) of established modifiable AF risk factors were ascertained. Results: In the MESA cohort, 47.2% was male; at baseline, 25.7% had hypertension; 12.5% had diabetes. Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3years. Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics, NHBs and Chinese compared with NHWs (all P<.001). Among participants 65years of age or greater, Hispanics, Chinese, and blacks had significantly lower AF incidence than NHWs (all P≤.01), but IRs were similar among participants under age 65 years. The PAF for smoking was 27% among NHBs but lower among other race-ethnic groups. Among NHWs, the PAF for hypertension was 22.2%, but this was higher among NHBs (33.1%), Chinese (46.3%), and Hispanics (43.9%). Conclusions: Overall, the incidence of hospitalized AF was significantly lower in Hispanics, NHBs, and Chinese than in NHWs. A larger proportion of AF events appear to be attributable to hypertension among nonwhite populations compared with NHWs.

Original languageEnglish (US)
Pages (from-to)71-76.e1
JournalAnnals of epidemiology
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2015

Bibliographical note

Funding Information:
This research was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-RR-024156 and UL1-RR-025005 from NCRR . The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org .

Funding Information:
Sources of Funding: This work was supported by a grant from the National Heart, Lung, and Blood Institute ( R01 HL104199 , Epidemiologic Determinants of Cardiac Structure and Function among Hispanics: C.J.R. principal investigator).

Keywords

  • Atrial fibrillation
  • Chinese
  • Epidemiology
  • Hispanics

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