Abstract 8847: Racial Differences in Competing Risks for First Cardiovascular Events and Non-Cardiovascular Death in Middle-Aged and Older Adults
Background: Standard survival models may over-estimate risks of incident cardiovascular disease (CVD) if they do not account for the competing risk of non-CVD death. No studies to date have compared first CVD events and non-CVD death between races in a competing risks framework.
Methods: Using data from 2 multi-center, NHLBI-sponsored cohorts (ARIC and CHS), we used competing Cox models to estimate hazards for first CVD events and non-CVD death within and between races.
Results: Of 14569 ARIC study participants (ppts) aged 45-64y with mean follow up of 10.5y, 11.6% had CVD and 5.0% had non-CVD death as a first event; among 4237 CHS study ppts aged 65-84y and followed for 8.5y, these figures were 43.2% and 15.7%, respectively. Figures 1 and 2 show competing cumulative incidence curves for ARIC men for specific event types. CVD events were significantly more likely to occur first rather than non-CVD death in all sex-race groups. Compared with whites, middle-aged blacks were 1.4-2.1 times more likely to have non-CVD death or CVD as first events; these disparities disappeared by older adulthood. After adjustment for CVD risk factors (RFs), however, middle-aged black men were less likely than whites to experience a first CVD event. Most likely first CVD events were CHD in white men and heart failure in black men and all women.
Conclusions: Our finding that CVD events are more likely than non-CVD death to occur first in all sex-race groups re-affirms the importance of broadly applied CVD prevention programs. CVD affects blacks at a younger age than whites; the earlier burden of CVD among black men may be due to elevated CVD RF levels. Racial disparities in first CVD incidence disappear by older adulthood.
- © 2011 by American Heart Association, Inc.