title: Association of race and sex with risk of incident acute coronary heart disease events.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: School of Medicine, University of Alabama, Birmingham, AL 35294, USA. msafford@uab.edu
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Todd M
authors.initials: TM
authors.lastname: Brown
authors.forename: Paul M
authors.initials: PM
authors.lastname: Muntner
authors.forename: Raegan W
authors.initials: RW
authors.lastname: Durant
authors.forename: Stephen
authors.initials: S
authors.lastname: Glasser
authors.forename: Jewell H
authors.initials: JH
authors.lastname: Halanych
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Prineas
authors.forename: Tandaw
authors.initials: T
authors.lastname: Samdarshi
authors.forename: Vera A
authors.initials: VA
authors.lastname: Bittner
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: Christopher
authors.initials: C
authors.lastname: Gamboa
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Virginia
authors.initials: V
authors.lastname: Howard
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American