Association of Race and Sex With Risk of Incident Acute Coronary Heart Disease Events
Open accessAbstract
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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Black Americans are more likely to smoke cigarettes and less likely to quit cigarette smoking compared with NHW, with high rates of menthol cigarette use.
“Black Americans are also more likely to smoke cigarettes and less likely to quit cigarette smoking compared with NHW with high rates of menthol cigarette use supporting current plans to regulate menthol tobacco products.32,33”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [33]
The Results, under Sample Characteristics (page not provided), say smoking was more prevalent among Black than white participants, supporting the smoking comparison. The paper does not report racial differences in quitting or menthol cigarette use; its Methods, under Covariates (page not provided), define current smoking but do not address either point. (LLM, conf=0.88)
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- Authors
- Safford, M. M., Brown, T. M., Muntner, P. M., Durant, R. W., Glasser, S., Halanych, J. H., Shikany, J. M., Prineas, R. J., Samdarshi, T., Bittner, V. A., Lewis, C. E., Gamboa, C., Cushman, M., Howard, V., Howard, G., & REGARDS Investigators, F. T.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Vermont (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-11-07
- Volume
- 308
- Issue
- 17
- Pages
- 1768
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3772637
- OpenAlex
- W2035962722
- Cited by
- 316
- References
- 48
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 7 · 2023: 21 · 2022: 21 · 2021: 27 · 2020: 29 · 2019: 30 · 2018: 31 · 2017: 29 · 2016: 29 · 2015: 27 · 2014: 23 · 2013: 16 · 2012: 3
- FWCI
- 14.20
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL080477, K24HL111154)
- National Institute of Neurological Disorders and Stroke (U01NS041588)
- National Center for Research Resources (KL2RR025776)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- acute coronary heart disease, racial disparities, sex differences, black-white disparities, myocardial infarction, non-ST-elevation myocardial infarction, coronary heart disease mortality, REGARDS cohort, coronary heart disease incidence
- MeSH terms
- Adult, Aged, Black or African American, Coronary Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Risk, Sex Factors, United States, Incidence, Black People, White People, Health Status Disparities
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