title: Racial differences in the prevalence of severe aortic stenosis.
abstract: BACKGROUND
  In an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies.
  
  
  RESULTS
  The Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de-identified patient records, was used to identify individuals who had undergone echocardiography. The association of race with severe aortic stenosis was examined using multivariable logistic regression analyses adjusting for conventional risk factors. Of the 272 429 eligible patients (mean age 45 years, 44% male) with echocardiography, 14% were African American and 82% were Caucasian. Severe aortic stenosis was identified in 106 (0.29%) African-American patients and 2030 (0.91%) Caucasian patients (crude OR 0.32, 95% CI [0.26, 0.38]). This difference persisted in multivariable-adjusted analyses (OR 0.41 [0.33, 0.50], P<0.0001). African-American individuals were also less likely to have severe aortic stenosis due to degenerative calcific disease (adjusted OR 0.47 [0.36, 0.61]) or congenitally bicuspid valve (crude OR 0.13 [0.02, 0.80], adjusted OR dependent on age). Referral bias against those with severe valvular disease was assessed by comparing the prevalence of severe mitral regurgitation in Caucasians and African Americans and no difference was found.
  
  
  CONCLUSIONS
  These findings suggest that African Americans are at significantly lower risk of developing severe aortic stenosis than Caucasians.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (D.K.P., M.F.).
authors.forename: Devin K
authors.initials: DK
authors.lastname: Patel
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.D.G., T.J.W., M.A.R.).
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Green
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (D.K.P., M.F.).
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN (F.E.H.).
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.D.G., T.J.W., M.A.R.).
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.D.G., T.J.W., M.A.R.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Robbins
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: aortic valve stenosis; database; epidemiology; race and ethnicity; risk factor