Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Background Despite a higher prevalence of risk factors, atrial fibrillation (AF) is less prevalent in blacks than whites. To address this paradox, we examined racial differences in the magnitude of AF risk associated with common risk factors. Methods Participants (13,688; mean age = 63 +/- 8.4 years; 56 % female; 37 % black) from the Reasons for Geographic And Racial Differences in Stroke study who were free of baseline AF were included. Incident AF was identified at a follow-up examination by electrocardiogram and selfreported medical history. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between risk factors and incident AF in blacks and whites, separately. Age-and sex-adjusted population attributable fractions (PAFs) of modifiable AF risk factors were computed. Results After median follow-up of 9.4 years, 997 (7.3 %) incident AF cases were detected. Black race was associated with a lower risk of AF (RR = 0.46, 95 % CI = 0.39, 0.53). Significant risk factors for AF were age, male sex, hypertension, obesity, and cardiovascular disease. A differential association was detected for smoking by race, with the association being stronger in blacks (RR = 1.41, 95 % CI = 1.07, 1.85) compared with whites (RR = 1.01, 95 % CI = 0.88, 1.16; P interaction = 0.030). The PAFs for hypertension (blacks = 27.4 %, whites = 19.4 %), obesity (blacks = 16.9 %, whites = 11.8 %), and smoking (blacks = 17.9 %, whites = 2.5 %) were higher for blacks than whites. Conclusion Modifiable risk factors are important in AF development among blacks despite a lower risk of the arrhythmia. Racial differences in the magnitude of the association of individual AF risk factors do not explain the AF paradox.