Association of Race and Major Adverse Cardiac Events (MACE): The Atherosclerosis Risk in Communities (ARIC) Cohort.

Ericha G Franey,Vibha Bhatnagar,Donna Kritz-Silverstein,Erin L Richard,Richard A Shaffer,John E Alcaraz,Caroline M Nievergelt

doi:10.1155/2020/7417242

Abstract

Background and Aims To evaluate the association of self-reported race with major adverse cardiac events (MACE) and modification of this association by paraoxonase gene (PON1, PON2, and PON3) single nucleotide polymorphisms (SNPs). Methods Included in this longitudinal study were 12,770 black or white participants from the Atherosclerosis Risk in Communities (ARIC) cohort who completed a baseline visit (1987–1989) with PON genotyping. Demographic, behavioral, and health information was obtained at baseline. MACE was defined as first occurrence of myocardial infarction, stroke, or CHD-related death through 2004. Cox proportional hazards regression was used to evaluate the association between race and MACE after adjustment for age, gender, and other demographic and cardiovascular risk factors such as diabetes and hypertension. Modification of the association between PON SNPs and MACE was also assessed. Results Blacks comprised 24.6% of the ARIC cohort; overall, 14.0% of participants developed MACE. Compared with whites, blacks had 1.24 times greater hazard of MACE (OR = 1.24,95%CI = 1.10,1.39) than whites after adjusting for age, gender, BMI, cigarette and alcohol use, educational and marital status, and aspirin use. This association became nonsignificant after further adjustment for high cholesterol, diabetes, and hypertension. None of the evaluated SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons. Conclusions No association between race and MACE was identified after adjusting for high cholesterol, diabetes, and hypertension, suggesting that comorbidities are major determinants of MACE; medical intervention with focus on lifestyle and health management could ameliorate the development of MACE. Further studies are needed to confirm this observation.

Highlights

IntroductionE purpose of this study was to evaluate the association of black and white race with major adverse cardiac events (MACE) and to evaluate the effect of paraoxonase single nucleotide polymorphisms (SNPs) on this association using data from a large cohort of older men and women (ARIC)
Cardiovascular disease (CVD) is the leading cause of death in most racial and ethnic groups in the United States including blacks and whites, accounting for 1 in 4 deaths. [1] Composite cardiovascular outcomes create an endpoint which includes first occurrence of prespecified cardiac events, commonly referred to as major adverse cardiac events (MACE), increasing statistical power and improving detectability of clinically meaningful differences. [2].e purpose of this study was to evaluate the association of black and white race with MACE and to evaluate the effect of paraoxonase single nucleotide polymorphisms (SNPs) on this association using data from a large cohort of older men and women (ARIC)
Blacks had a lower proportion of current alcohol use (p < 0.0001) and fewer had attained a high school education (p < 0.0001), were married (p < 0.0001) or reported aspirin use (p < 0.0001) than whites

Summary

Introduction

E purpose of this study was to evaluate the association of black and white race with MACE and to evaluate the effect of paraoxonase single nucleotide polymorphisms (SNPs) on this association using data from a large cohort of older men and women (ARIC). Included in this longitudinal study were 12,770 black or white participants from the Atherosclerosis Risk in Communities (ARIC) cohort who completed a baseline visit (1987–1989) with PON genotyping. Cox proportional hazards regression was used to evaluate the association between race and MACE after adjustment for age, gender, and other demographic and cardiovascular risk factors such as diabetes and hypertension. No association between race and MACE was identified after adjusting for high cholesterol, diabetes, and hypertension, suggesting that comorbidities are major determinants of MACE; medical intervention with focus on lifestyle and health management could ameliorate the development of MACE.

Methods

Results

Discussion

Conclusion