Higher stroke rate in East Asian adults than white adults, regardless of relationship to AF

Key points to remember:

• East Asian adults had a higher stroke rate than white adults.
• The presence of atrial fibrillation increased the risk of stroke similarly in both groups.

In a comparison of two cohorts, stroke rate was higher in East Asian adults than in white adults, although atrial fibrillation influenced stroke rate equally in both groups , the researchers reported at Heart Rhythm 2023.

The researchers conducted a patient-level comparative analysis of East Asian participants of the Korean National Health Insurance Service – Health Screening cohort (n=446,986; mean age, 56 years; 54% male) and white participants from the UK Biobank cohort (n=403,240; mean age, 57 years; 46% male).

“Contemporary guidelines require an integrated approach to prevention and treatment of complications associated with atrial fibrillation. However, most of the evidence for this is based on studies of mainstream Western populations; i.e. the white populations”, Boyoung Joung, MD, professor of cardiology and internal medicine at Yonsei University College of Medicine in Seoul, South Korea, Healio told. “Therefore, it is difficult to apply the guideline recommendations to the daily practice of other ethnicities. A better understanding of breed-specific features of AF will not only aid in medical planning and resource allocation, but will also guide interventions to address and mitigate disparities. Additionally, our team has a strong advantage in elucidating these racial differences, as we have baseline data for medical services for nearly one million individuals.

The outcome of interest was ischemic or hemorrhagic stroke, whether related to AF or not. The mean follow-up in the East Asian cohort was 7.3 years. The mean follow-up in the white cohort was 11.7 years.

Among people without AF, incidence rates of ischemic or hemorrhagic stroke were higher in East Asian adults than in white adults (0.36 per 100 person-years versus 0.1 per 100 person-years -people ; P < 0.001) and the same was true for people with AF (1.92 per 100 person-years versus 0.55 per 100 person-years; P < .001), according to the researchers.

Boyoung Young

“East Asians in Korea were found to have more cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia than the white comparison group, even at a younger age,” said Joung to Healio. “This is partly attributed to lower unfavorable outcomes compared to whites, regardless of atrial fibrillation condition. Of course, future considerations should also include the effects of unadjusted confounding variables in this study, such as salt sensitivity, dietary habits, and extreme weather conditions.

The presence of AF increased the risk of stroke similarly in both groups (RR in East Asian cohort = 2.62; 95% CI, 2.38-2.87; RR in the white cohort = 2.85, 95% CI, 2.6-3.13; P for the interaction = 0.09), Joung and colleagues found.

“There appears to be a need for thorough screening and early treatment of poorly controlled comorbidities among East Asians,” Joung told Healio. “Furthermore, the results of this study did not provide a clear answer as to whether these differences are truly due to race or to learned changes such as lifestyle habits. Therefore, we believe that the use Patient-level data on East Asians living in Western societies could provide some insight into this, and we are currently conducting an analysis on this.

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