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Risk Factors for Coronary Heart Disease in African Americans
The Atherosclerosis Risk in Communities Study, 1987-1997
Daniel W. Jones, MD;
Lloyd E. Chambless, PhD;
Aaron R. Folsom, MD;
Gerardo Heiss, MD;
Richard G. Hutchinson, MD;
A. Richey Sharrett, MD,DrPh;
Moyses Szklo, MD,DrPh;
Herman A. Taylor, Jr, MD
Arch Intern Med. 2002;162:2565-2571.
Background As part of the Atherosclerosis Risk in Communities Study, the race-specific incidence rates and risk factor prediction for coronary heart disease (CHD) were determined for black and white persons over 7 to 10 years of follow-up, from 1987 to 1997.
Methods The sample included 14 062 men and women (2298 black women, 5686 white women, 1396 black men, and 4682 white men) aged 45 to 64 years who were free of clinical CHD at baseline.
Results Average age-adjusted incidence rates (95% confidence intervals) for CHD per 1000 person-years were as follows: black women, 5.1 (4.2-6.2); white women, 4.0 (3.5-4.6); black men, 10.6 (8.9-12.7); and white men, 12.5 (11.5-13.7). Incidence rates (95% confidence intervals) using a definition for CHD that excluded revascularization procedures were as follows: black women, 4.9 (4.6-6.0); white women, 2.9 (2.5-3.4); black men, 9.2 (7.6-11.1); and white men, 7.9 (7.0-8.8). In a multivariable analysis, hypertension was a particularly strong risk factor in black women, with hazard rate ratios (95% confidence intervals) as follows: black women, 4.8 (2.5-9.0); white women, 2.1 (1.6-2.9); black men, 2.0 (1.3-3.0); and white men, 1.6 (1.3-1.9). Diabetes mellitus was somewhat more predictive in white women than in other groups. Hazard rate ratios (95% confidence intervals) were as follows: black women, 1.8 (1.2-2.8); white women, 3.3 (2.4-4.6); black men, 1.6 (1.1-2.5); and white men, 2.0 (1.6-2.6). Low-density lipoprotein cholesterol level was similarly predictive in all race-sex groups (hazard rate ratio, 1.2-1.4 per SD increment of low-density lipoprotein cholesterol level). High-density lipoprotein cholesterol level seemed somewhat more protective in white than in black persons.
Conclusions Findings from this study, along with clinical trial evidence showing efficacy, support aggressive management of traditional risk factors in black persons, as in white persons. Understanding the intriguing racial differences in risk factor prediction may be an important part of further elucidating the causes of CHD and may lead to better methods of preventing and treating CHD.
From the Divisions of Hypertension (Dr Jones) and Cardiology (Drs Hutchinson and Taylor), the Department of Medicine, The University of Mississippi Medical Center, Jackson; the Departments of Biostatistics (Dr Chambless) and Epidemiology (Dr Heiss), School of Public Health, University of North Carolina at Chapel Hill; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Folsom); National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Sharrett); and the Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Md (Dr Szklo).
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