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. 2012 Nov 7;308(17):1768-74.
doi: 10.1001/jama.2012.14306.

Association of race and sex with risk of incident acute coronary heart disease events

Monika M Safford  1 , Todd M Brown, Paul M Muntner, Raegan W Durant, Stephen Glasser, Jewell H Halanych, James M Shikany, Ronald J Prineas, Tandaw Samdarshi, Vera A Bittner, Cora E Lewis, Christopher Gamboa, Mary Cushman, Virginia Howard, George Howard; REGARDS Investigators
Affiliations

Association of race and sex with risk of incident acute coronary heart disease events

Monika M Safford et al. JAMA. .

Abstract

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 24,443 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 [MI]; very small non-ST-elevation MI [NSTEMI] had peak troponin level <0.5 μg/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, 254 in white men, and 114 in white women). Among men, the age-standardized incidence rate per 1000 person-years for total CHD was 9.0 (95% CI, 7.5-10.8) for blacks vs 8.1 (95% CI, 6.9-9.4) for whites; fatal CHD: 4.0 (95% CI, 2.9-5.3) vs 1.9 (95% CI, 1.4-2.6), respectively; and nonfatal CHD: 4.9 (95% CI, 3.8-6.2) vs 6.2 (95% CI, 5.2-7.4). Among women, the age-standardized incidence rate per 1000 person-years for total CHD was 5.0 (95% CI, 4.2-6.1) for blacks vs 3.4 (95% CI, 2.8-4.2) for whites; fatal CHD: 2.0 (95% CI, 1.5-2.7) vs 1.0 (95% CI, 0.7-1.5), respectively; and nonfatal CHD: 2.8 (95% CI, 2.2-3.7) vs 2.2 (95% CI, 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% CI, 0.51-0.91) for men and 0.81 (95% CI, 0.58-1.15) for women. Of the 444 nonfatal 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.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Brown reported receiving grants from Amgen Pharmaceuticals not related to this article. Dr Muntner reported serving on an Amgen advisory board in 2011; serving as a consultant to Amgen; and receiving grants from Amgen. Dr Lewis reported receiving a grant from NovoNordisk for an obesity study. No other authors reported any disclosures.

Figures

Figure
Figure
Data are through December 31, 2009. Error bars indicate 95% confidence intervals. The P values for the differences between black and white men are total CHD, P = .30; fatal CHD, P < .001; and nonfatal CHD, P = .07. The P values for the differences between black and white women are total CHD, P = .002; fatal CHD, P = .003; and nonfatal CHD, P = .10.
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