Racial Differences in Recurrent Acute Myocardial Infarction: Findings From the ARIC Cohort
Duygu Islek1,2, Alvaro Alonso1, Wayne Rosamond3
1Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA.
Journal of the American Heart Association
|December 18, 2025
Summary
Black individuals experience higher rates of recurrent heart attacks and fatal heart disease after a first event compared to White individuals. Socioeconomic and cardiovascular risk factors largely explain these disparities in outcomes.
Area of Science:
- Cardiovascular epidemiology
- Health disparities research
- Clinical outcomes research
Background:
- Investigated racial disparities in recurrent nonfatal acute myocardial infarction (AMI) and fatal coronary heart disease (CHD).
- Focused on Atherosclerosis Risk in Communities (ARIC) cohort participants surviving a first AMI.
- Assessed the role of socioeconomic and cardiovascular risk factors in observed racial differences.
Purpose of the Study:
- To determine if racial differences exist in recurrent AMI and fatal CHD.
- To identify the extent to which socioeconomic and cardiovascular risk factors explain these disparities.
- To analyze outcomes in a cohort of individuals who have already experienced a first AMI.
Main Methods:
- Analyzed data from 422 Black and 1245 White ARIC participants who survived an incident AMI.
- Calculated incidence rates of recurrent AMI and fatal CHD by race.
- Utilized proportional hazards models, adjusting for socioeconomic and cardiovascular risk factors, to examine racial differences.
Main Results:
- Black participants had higher incidence rates of recurrent nonfatal AMI (32.4 vs. 22.8 per 1000 person-years) and fatal CHD (34.2 vs. 17.9 per 1000 person-years) compared to White participants.
- Age- and sex-adjusted models showed significantly higher hazard ratios for recurrent nonfatal AMI (1.70) and fatal CHD (2.10) in Black versus White participants.
- Racial differences in outcomes were not statistically significant after adjusting for socioeconomic and cardiovascular risk factors.
Conclusions:
- Black participants exhibit higher rates of recurrent nonfatal AMI and fatal CHD post-initial AMI compared to White participants.
- Observed racial disparities in cardiovascular outcomes are predominantly explained by differences in socioeconomic status and cardiovascular risk factors.
- These findings highlight the importance of addressing social determinants of health and managing cardiovascular risk factors to reduce racial inequities in heart disease.
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