Abstract
Objectives. Little is known about the epidemiology of sick sinus syndrome (SSS). The goals of this study were to determine the age and sex-specific incidence of SSS in white and black participants in the Atherosclerosis Risk In Communities (ARIC) study and the Cardiovascular Health Study (CHS), and to investigate associations of CV risk factors with incident SSS. Methods. From among ARIC (n=15,792) and CHS (n=5,888) participants, we included those who at baseline were free of prevalent atrial fibrillation and pacemaker, had a heart rate of ≥50bpm unless using beta blockers, and reported white or black race. Potential incident SSS cases were identified by ICD9 hospital discharge diagnosis code 427.81 and validated by medical record review. Incidence rates of SSS were calculated for each age-sex-race category. Age, sex, race, and clinic adjusted Cox models were used to assess associations of risk factors with incident SSS; estimates were combined across cohorts using fixed-effects meta-analysis. Results. At baseline, the average age of included participants (n=19,146) was 60 years. Traditional CV risk factors were more prevalent among blacks. During 324,505 person years of follow-up (mean 17 years), 291 incident SSS cases were identified, 246 in whites and 45 in blacks. Incidence estimates and associations with CV risk factors were similar in ARIC and CHS. SSS incidence increased with age (Table), and blacks had a 44% lower risk of SSS than whites (age, sex, and clinic adjusted HR: 0.56, 95%CI: 0.27, 1.20). In multivariate models, incident SSS was associated with greater BMI, height, NT-proBNP, cystatin C, and QRS interval, with lower heart rate and HDL cholesterol, and with prevalent hypertension, diabetes, right bundle branch block, CHD, and HF. Conclusions. The incidence of hospitalized SSS increased with age, and was lower for blacks than whites. Several modifiable CV risk factors were associated with incident hospitalized SSS.
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