Racial differences in the prevalence of atrial fibrillation among males

Despite being the most common cardiac arrhythmia, little is known about racial differences in atrial fibrillation (AF) prevalence and whether differences persist after accounting for known risk factors.

We identified male respondents to the 1999 Large Health Survey of Veteran Enrollees who had an AF diagnosis in the VA administrative database during the preceding two years.

Of 664,754 male respondents, 5.3% had AF. By race, age-adjusted prevalence was 5.7% in whites, 3.4% in blacks, 3.0% in Hispanics, 5.4% in native Americans/Alaskans, 3.6% in Asians and 5.2% in Pacific Islanders (p<0.001). Of predisposing conditions, whites were more likely to have valvular heart disease, coronary artery disease and congestive heart failure, blacks had the highest hypertension prevalence; Hispanics had the highest diabetes prevalence. Racial differences remained after adjustment for age, body mass index and these comorbidities. White males were significantly more likely to have AF compared to all races but Pacific Islanders [versus blacks, OR=1.84 (95% CI: 1.71-1.98); versus Hispanics, OR=1.77 (1.60-1.97); vs Native Americans, OR 1.15 [1.04-1.27]; versus Asians, OR=1.41 (1.12-1.77) versus Pacific Islanders, OR=1.16 (0.88-1.53)].

AF prevalence varies by race. White males have the highest AF burden even after adjustment for known risk factors. Recognition of the high AF prevalence, especially among whites, as well as native Americans and Pacific Islanders, should help guide provider practices for screening among older male patients. Further research is necessary to verify and establish reasons for these racial differences.