Atrial fibrillation and ethnicity: the known, the unknown and the paradox
Atrial fibrillation and ethnicity: the known, the unknown and the paradox
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DOI：
10.2217/fca.09.49
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发表时间：
2009-11-01
影响因子：
1.7
通讯作者：
Goff, David C., Jr.
中科院分区：
文献类型：
--
作者：
Soliman, Elsayed Z.;Alonso, Alvaro;Goff, David C., Jr.
目前对房颤（AF）的病理生理学和流行病学的了解主要基于对欧洲血统的白人人群的研究，而非白人人群的数据有限。许多传统的和新的房颤危险因素已经确定。然而，对于这些房颤风险因素在非白人和白人人群中的差异影响知之甚少。很少有研究比较黑人和白人的房颤患病率和发病率，更少将这种比较扩展到其他种族和民族。这几项研究一致表明，黑人的心房颤动负担比白人低。这些发现与报道的黑人人群中高卒中发生率以及卒中与房颤之间的强相关性不一致。从这个角度来看，我们认为不同种族和民族群体对房颤的差异不确定可能是解释房颤种族/民族分布矛盾的关键。最近发表的研究结果表明，如果使用更敏感的房颤检测方法，黑人房颤发病率会更高。虽然这些发现没有达到明确证据的水平，但它们可能支持在检测AF的有限方法的背景下重新思考AF跨种族和民族流行病学的必要性，以及不同种族/民族诊断AF的能力相同的可疑假设。
Current understanding of the pathophysiology and epidemiology of atrial fibrillation (AF) is based primarily on studies in White populations of European ancestry with limited data on the non-White populations. Many traditional and novel risk factors for AF have been already established. However, little is known about the differential impact of these AF risk factors in non-White versus White populations. Few studies have compared the prevalence and incidence of AF in Black versus White individuals, and still fewer extended this comparison to other races and ethnicities. These few studies consistently reported that Black individuals have lower AF burden compared with their White counterparts. These findings are not consistent with the reported high stroke rates in Black populations and the strong association between stroke and AF. In this perspective we argue that differential AF underascertainment among different racial and ethnic groups may be the key in explaining this paradox of racial/ethnic distribution of AF. Results from recent publications suggest that Black individuals would have higher rates of AF if more sensitive AF detection methods are used. Although these findings do not reach the level of definitive evidence, they may support the need for rethinking the epidemiology of AF across races and ethnicities in the context of the limited methodology available to detect AF, as well as the questionable assumption that the ability to diagnose AF across dif ferent racial/ethnic groups is the same.