Atrial fibrillation in an African-American cohort: The Jackson Heart Study

Background: Atrial fibrillation (AF) is an important public health problem across race/ethnic groups. Data from US cohort studies initiated in the 1980s suggest a higher prevalence of AF risk factors among African-Americans (AAs) than whites, but lower AF incidence. The Jackson Heart Study (JHS) is a community-based study of 5306 AAs recruited starting in 2000. Hypothesis: Demographic, anthropometric, cardiovascular, and/or electrocardiographic factors are associated with AF incidence in JHS. Methods: Using baseline participant characteristics and incident AF identified through hospital surveillance, study electrocardiogram, and Medicare claims, we estimated age-and sex-specific AF incidence rates, compared them with rates in AA participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and Cardiovascular Health Study (CHS), and examined associations of cardiovascular risk factors with AF. Results: A total of 66 participants had prevalent AF at baseline. Over an average follow-up of 8.5 years, 242 cases of incident AF were identified. Age-and sex-specific AF incidence rates in JHS were similar to those among AAs in MESA and appeared slightly lower than those among AAs in CHS. In an age-and sex-adjusted model, associations with incident AF were observed for modifiable risk factors: high body weight (HR = 1.23 per 15 kg, 95% CI 1.13-1.35), systolic blood pressure (HR = 1.29 per 20 mmHg, 95% CI 1.13-1.47), and current smoking (HR = 1.80, 95% CI 1.27-2.55). Risk estimates associated with these risk factors were only slightly attenuated after multivariable adjustments. Conclusions: These findings underscore the potential additional benefits of interventions for weight management, control of hypertension, and smoking cessation for the prevention of AF among AAs.