Association of Race and Sex With Risk of Incident Acute Coronary Heart Disease Events

摘要

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 24443 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 [Ml]; very small non-ST-elevation Ml [NSTEMI] had peak troponin level <0.5 ug/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, 254in white men, and 114 in white women). Among men, the age-standardized incidence rate per 1000 person-years fortotal CHD was9.0(95% 0,7.5-10.8) for blacks vs 8.1 (95% Cl, 6.9-9.4) for whites; fatal CHD: 4.0 (95% Cl, 2.9-5.3) vs 1.9 (95% Cl, 1.4-2.6), respectively; and nonfatal CHD: 4.9 (95% Cl, 3.8-6.2) vs 6.2 (95% Cl, 5.2-7.4). Among women, the age-standardized incidence rate per 1000 person-years fortotal CHD was 5.0 (95% Cl, 4.2-6.1) for blacks vs 3.4 (95% Cl, 2.8-4.2) for whites; fatal CHD: 2.0 (95% Cl, 1.5-2.7) vs 1.0 (95% Cl, 0.7-1.5), respectively; and nonfatal CHD: 2.8 (95% Cl, 2.2-3.7) vs2.2 (95% Cl, 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% Cl, 0.51-0.91) for men and 0.81 (95% Cl, 0.58-1.15) for women. Of the 444 non-fatal 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.