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.
Insights
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.
Background:
We examined racial differences in recurrent nonfatal acute myocardial infarction (AMI) and fatal coronary heart disease (CHD) among ARIC (Atherosclerosis Risk in Communities) cohort participants who survived a first AMI (1987-2017) and assessed whether socioeconomic and cardiovascular risk factors contribute to observed differences.
Methods:
We analyzed 422 Black and 1245 White ARIC participants who survived an incident AMI during follow-up. Incidence rates of recurrent AMI and fatal CHD were calculated by race. Proportional hazards models examined differences after adjustment for socioeconomic and cardiovascular risk factors, with race-sex interactions tested.
Results:
The mean±SD age at the time of the first incident AMI was 69.3±9.0 years for Black and 70.7±9.5 years for White participants. The incidence rate per 1000 person-years was higher in Black participants than White participants both for recurrent nonfatal AMI (incidence rate, 32.4 [95% CI, 26.8-38.8] versus 22.8 [95% CI, 20.2-25.6]) and for fatal CHD (34.2 [95% CI, 28.4-40.7] versus 17.9 [95% CI, 15.7-20.4]). In age- and sex-adjusted models, the hazard ratios comparing Black versus White participants were 1.70 (95% CI, 1.36-2.13) for recurrent nonfatal AMI and 2.10 (95% CI, 1.67-2.34) for fatal CHD. The racial differences were statistically not significant after adjustment for socioeconomic and cardiovascular risk factors. There were no significant race and sex interactions for outcomes.
Conclusions:
Black participants have higher rates of recurrent nonfatal AMI and fatal CHD after an initial AMI compared with White participants. These disparities are mostly explained by socioeconomic and cardiovascular risk factors.
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