Risk factors for coronary heart disease in African Americans: the atherosclerosis risk in communities study, 1987-1997.
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.
Jones
Daniel W
DW
Division of Hypertension, Department of Medicine, The University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216-4505, USA. djones@ovc.umsmed.edu
Chambless
Lloyd E
LE
Folsom
Aaron R
AR
Heiss
Gerardo
G
Hutchinson
Richard G
RG
Sharrett
A Richey
AR
Szklo
Moyses
M
Taylor
Herman A
HA
D017677:Age Distribution; D044383:Black People / Q000235:genetics*; D015331:Cohort Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D012307:Risk Factors; D012494:Sampling Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000235:genetics*; D001741:Black or African American