Advertisement

Prevalence of atrial fibrillation and association with clinical, sociocultural, and ancestral correlates among Hispanic/Latinos: The Hispanic Community Health Study/Study of Latinos

      Background

      Hispanics/Latinos represent the largest ethnic minority group in the United States. Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States.

      Objective

      The purpose of this study was to provide data on the prevalence of AF and its correlates in a representative Hispanic/Latino population–based sample inclusive of all background groups.

      Methods

      Hispanic Community Health Study/Study of Latinos participants (n=16,415; 60% women; 59% age >45 years) were enrolled between March 2008 and June 2011, representing individuals of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American heritage. AF was defined by the 12-lead electrocardiogram and/or participant self-report of a physician diagnosis. Hispanic background–specific AF prevalence rates were determined. Weighted sequential logistic regression models were adjusted for demographic factors (age and sex) and clinical variables (diabetes, hypertension, body mass index, tobacco use, and estimated glomerular filtration rate).

      Results

      The overall weighted prevalence of AF was 1.0% (n=162), with the highest prevalence in Hispanics of Dominican and Puerto Rican backgrounds (1.9% and 2.5% respectively) and the lowest in those of Mexican background (0.3%). Diabetes, hypertension, renal disease, left ventricular hypertrophy determined by the electrocardiogram, alcohol use, and English language preference (greater acculturation) (P < .01 for all) were significantly associated with higher AF prevalence. Multivariate analysis by Hispanic/Latino background group showed that Hispanics of Dominican and Puerto Rican backgrounds were at a 3- to 6-fold higher risk of AF than their Mexican counterparts.

      Conclusion

      In a diverse representative population of Hispanics/Latinos, overall AF prevalence was low and varied significantly across Hispanic/Latino background groups independent of clinical or demographic factors.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • US Census Bureau
        Quick Facts United States.
        (Population estimates, July 1, 2018 (V2018)) (Accessed January 7, 2019)
        • Conomos M.P.
        • Laurie C.A.
        • Stilp A.M.
        • et al.
        Genetic diversity and association studies in US Hispanic/Latino populations: applications in the Hispanic Community Health Study/Study of Latinos.
        Am J Hum Genet. 2016; 98: 165-184
        • Rodriguez C.J.
        • Allison M.
        • Daviglus M.L.
        • et al.
        • Council on Epidemiology and Prevention; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular and Stroke Nursing
        Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association.
        Circulation. 2014; 130: 593-625
        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • et al.
        Heart Disease and Stroke Statistics—2017 update: a report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • et al.
        Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Wolf P.A.
        • Abbott R.D.
        • Kannel W.B.
        Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.
        Stroke. 1991; 22: 983-988
        • Rane S.
        • Patton K.K.
        Impact of sex and ethnicity on arrhythmic risk.
        Curr Cardiol Rep. 2015; 17: 604
        • Rodriguez C.J.
        • Soliman E.Z.
        • Alonso A.
        • et al.
        Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis.
        Ann Epidemiol. 2015; 25: 71-76, 76.e71
        • Borzecki A.M.
        • Bridgers D.K.
        • Liebschutz J.M.
        • Kader B.
        • Kazis L.E.
        • Berlowitz D.R.
        Racial differences in the prevalence of atrial fibrillation among males.
        J Natl Med Assoc. 2008; 100: 237-245
        • Alonso A.
        • Agarwal S.K.
        • Soliman E.Z.
        • et al.
        Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study.
        Am Heart J. 2009; 158: 111-117
        • Lavange L.M.
        • Kalsbeek W.D.
        • Sorlie P.D.
        • et al.
        Sample design and cohort selection in the Hispanic Community Health Study/Study of Latinos.
        Ann Epidemiol. 2010; 20: 642-649
        • Sorlie P.D.
        • Aviles-Santa L.M.
        • Wassertheil-Smoller S.
        • et al.
        Design and implementation of the Hispanic Community Health Study/Study of Latinos.
        Ann Epidemiol. 2010; 20: 629-641
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2010; 33: S62-S69
        • Alexander D.H.
        • Novembre J.
        • Lange K.
        Fast model-based estimation of ancestry in unrelated individuals.
        Genome Res. 2009; 19: 1655-1664
        • Ball J.
        • Carrington M.J.
        • McMurray J.J.
        • Stewart S.
        Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century.
        Int J Cardiol. 2013; 167: 1807-1824
        • Shen A.Y.
        • Contreras R.
        • Sobnosky S.
        • et al.
        Racial/ethnic differences in the prevalence of atrial fibrillation among older adults—a cross-sectional study.
        J Natl Med Assoc. 2010; 102: 906-913
        • Wyse D.G.
        • Van Gelder I.C.
        • Ellinor P.T.
        • et al.
        Lone atrial fibrillation: does it exist?.
        J Am Coll Cardiol. 2014; 63: 1715-1723
        • Sorlie P.D.
        • Allison M.A.
        • Aviles-Santa M.L.
        • et al.
        Prevalence of hypertension, awareness, treatment, and control in the Hispanic Community Health Study/Study of Latinos.
        Am J Hypertens. 2014; 27: 793-800
        • Pabon-Nau L.P.
        • Cohen A.
        • Meigs J.B.
        • Grant R.W.
        Hypertension and diabetes prevalence among U.S. Hispanics by country of origin: the National Health Interview Survey 2000-2005.
        J Gen Intern Med. 2010; 25: 847-852
        • Rodriguez C.J.
        • Sciacca R.R.
        • Diez-Roux A.V.
        • et al.
        Relation between socioeconomic status, race–ethnicity, and left ventricular mass.
        Hypertension. 2004; 43: 775-779
        • Marcus G.M.
        • Alonso A.
        • Peralta C.A.
        • et al.
        European ancestry as a risk factor for atrial fibrillation in African Americans.
        Circulation. 2010; 122: 2009-2015
        • Dewland T.A.
        • Olgin J.E.
        • Vittinghoff E.
        • Marcus G.M.
        Incident atrial fibrillation among Asians, Hispanics, blacks, and whites.
        Circulation. 2013; 128: 2470-2477
        • Daviglus M.L.
        • Talavera G.A.
        • Aviles-Santa M.L.
        • et al.
        Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.
        JAMA. 2012; 308: 1775-1784
        • Marmot M.G.
        • Syme S.L.
        Acculturation and coronary heart disease in Japanese-Americans.
        Am J Epidemiol. 1976; 104: 225-247
        • Lopez L.
        • Peralta C.A.
        • Lee A.
        • Zeki Al Hazzouri A.
        • Haan M.N.
        Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans.
        Ann Epidemiol. 2014; 24: 714-719
        • Zambrana R.E.
        • Carter-Pokras O.
        Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos.
        Am J Public Health. 2010; 100: 18-23
        • Soliman E.Z.
        • Alonso A.
        • Goff Jr., D.C.
        Atrial fibrillation and ethnicity: the known, the unknown and the paradox.
        Future Cardiol. 2009; 5: 547-556
        • Soliman E.Z.
        • Howard G.
        • Meschia J.F.
        • et al.
        Self-reported atrial fibrillation and risk of stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
        Stroke. 2011; 42: 2950-2953
        • Psaty B.M.
        • Manolio T.A.
        • Kuller L.H.
        • et al.
        Incidence of and risk factors for atrial fibrillation in older adults.
        Circulation. 1997; 96: 2455-2461
        • Prineas R.J.
        • Soliman E.Z.
        • Howard G.
        • et al.
        The sensitivity of the method used to detect atrial fibrillation in population studies affects group-specific prevalence estimates: ethnic and regional distribution of atrial fibrillation in the REGARDS study.
        J Epidemiol. 2009; 19: 177-181