Author + information
- Received July 27, 2018
- Revision received August 13, 2018
- Accepted August 14, 2018
- Published online November 12, 2018.
- Rajat Deo, MD, MTRa,∗ (, )
- Monika M. Safford, MDb,
- Yulia A. Khodneva, MD, PhDc,
- Deanna P. Jannat-Khah, DrPH, MSPHb,
- Todd M. Brown, MD, MSPHc,
- Suzanne E. Judd, PhD, MPHd,e,
- William M. McClellan, MD, MPHf,†,
- J. David Rhodes, BSN, MPHe,
- Michael G. Shlipak, MD, MPHg,h,
- Elsayed Z. Soliman, MD, MSc, MSi and
- Christine M. Albert, MD, MPHj
- aElectrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- bDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
- cDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- dDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- eDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- fDepartments of Medicine and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- gDepartment of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, California
- hDepartment of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
- iEpidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North Carolina
- jCenter for Arrhythmia Prevention, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Rajat Deo, 3400 Spruce Street, 9 Founders Cardiology, Philadelphia, Pennsylvania 19104.
Background Prior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data.
Objectives The purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias.
Methods The Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed.
Results Among 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77).
Conclusions In a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.
↵† Dr. McClellan is deceased.
This research project is supported by a cooperative agreement U01-NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. Additional support was provided by grants R01-HL080477 and K24-HL111154 from the National Heart, Lung, and Blood Institute. Representatives of the National Institutes of Health have been involved in the review of the manuscript but were not directly involved in the collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. This project was also supported, in part, by the Winkelman Family Fund in Cardiovascular Innovation. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 27, 2018.
- Revision received August 13, 2018.
- Accepted August 14, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.