Key result
Black individuals had a higher incidence of sudden cardiac death compared to white individuals (2.86 vs 1.37 per 1000 person-years), and race did not modify the association of electrophysiological substrate with sudden cardiac death.
Why the study?
Because race is an established risk factor for sudden cardiac death, this study sought to determine whether the association of electrophysiological substrate with sudden cardiac death varies between Black and White individuals.
Does electrophysiological substrate explain racial disparities in sudden cardiac death between black and white individuals?
Cohort (n=14,408)
Yes
Does electrophysiological substrate explain racial disparities in sudden cardiac death between black and white individuals?
Absolute Event Rate: 2.86% vs 1.37%
Electrophysiological substrate metrics are similarly associated with sudden cardiac death in black and white individuals, indicating that EP substrate does not explain the two-fold higher SCD rate observed in black individuals.
EP substrate does not explain racial SCD disparities; leaves open alternative mechanisms in this observational cohort.
Race is an established risk factor for sudden cardiac death (SCD). We sought to determine whether the association of electrophysiological (EP) substrate with SCD varies between black and white individuals. Participants from the Atherosclerosis Risk in Communities study with analyzable ECGs (n=14,408; age 54±6 y; 74% white) were included. EP substrate was characterized by traditional 12-lead ECG and vectorcardiographic metrics. Two competing outcomes were adjudicated SCD and non-sudden cardiac death (nonSCD). Interaction of ECG metrics with race was studied in Cox proportional hazards and Fine-Gray competing risk models, adjusted for prevalent cardiovascular disease (CVD), risk factors, and incident non-fatal CVD. At the baseline visit linear regression analysis, adjusted for age, sex, and study center, showed black individuals had larger Spatial Ventricular Gradient magnitude by 0.30 (95%CI 0.25-0.34) mV, SAI QRST by 18.4 (13.7-23.0) mV*ms, Cornell voltage by 0.30 (95%CI 0.25-0.35) mV than white individuals. Over a median follow-up of 24.4 years, SCD incidence was higher in black (2.86; 95%CI 2.50-3.28 per 1000 person-years) than white individuals (1.37; 95%CI 1.22-1.53 per 1000 person-years). Black individuals with hypertension had the highest rate of SCD: 4.26; 95%CI 3.66-4.96 per 1000 person-years. Race did not modify associations of EP substrate with SCD and nonSCD. EP substrate does not explain racial disparities in SCD rate.
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Jensen et al. (2019) conducted a cohort in Sudden cardiac death (n=14,408). Black race vs. White race was evaluated on Sudden cardiac death incidence (per 1000 person-years). Black individuals had a higher incidence of sudden cardiac death compared to white individuals (2.86 vs 1.37 per 1000 person-years), and race did not modify the association of electrophysiological substrate with sudden cardiac death.
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