TY - JOUR
T1 - Racial differences in electrocardiographic characteristics and prognostic significance in Whites versus Asians
AU - Santhanakrishnan, Rajalakshmi
AU - Wang, Na
AU - Larson, Martin G.
AU - Magnani, Jared M.
AU - Vasan, Ramachandran S.
AU - Wang, Thomas J.
AU - Yap, Jonathan
AU - Feng, Liang
AU - Yap, Keng B.
AU - Ong, Hean Y.
AU - Ng, Tze P.
AU - Richards, Arthur Mark
AU - Lam, Carolyn S.P.
AU - Ho, Jennifer E.
N1 - Publisher Copyright:
© 2016 The Authors.
PY - 2015
Y1 - 2015
N2 - Background: Racial differences in electrocardiographic (ECG) characteristics and prognostic significance among Whites and Asians are not well described. Methods and Results: We studied 2677 White Framingham Heart Study participants (57% women) and 2972 Asian (64% women) Singapore Longitudinal Aging Study participants (mean age 66 years in both) free of myocardial infarction or heart failure. Racial differences in ECG characteristics and effect on mortality were assessed. In linear regression models, PR interval was longer in Asians compared with Whites (multivariable-adjusted β±SE 5.0±1.4 ms in men and 6.6±0.9 ms in women, both P<0.0006). QT interval was shorter in Asian men (β±SE -6.2±1.2 ms, P<0.0001) and longer in Asian women (β±SE 3.6±0.9 ms, P=0.02) compared to White men and women, respectively. Asians had greater odds of having ECG left ventricular hypertrophy (LVH) compared with Whites (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.36-9.35 for men, OR 1.93, 95% CI 1.35-2.76 for women, both P<0.02). Over a mean follow-up of 11±3 years in Framingham and 8±3 years in Singapore, mortality rates were 24.5 and 13.4 per 1000 person-years among Whites and Asians, respectively. In Cox models, the presence of LVH had a greater effect on all-cause mortality in Asians compared with Whites (hazard ratio [HR] 2.66, 95% CI 1.83-3.88 vs HR 1.30, 95% CI 0.90-1.89, P for interaction=0.02). Conclusion: Our findings from two large community-based cohorts show prominent race differences in ECG characteristics between Whites and Asians, and also suggest a differential association with mortality. These differences may carry implications for race-specific ECG reference ranges and cardiovascular risk.
AB - Background: Racial differences in electrocardiographic (ECG) characteristics and prognostic significance among Whites and Asians are not well described. Methods and Results: We studied 2677 White Framingham Heart Study participants (57% women) and 2972 Asian (64% women) Singapore Longitudinal Aging Study participants (mean age 66 years in both) free of myocardial infarction or heart failure. Racial differences in ECG characteristics and effect on mortality were assessed. In linear regression models, PR interval was longer in Asians compared with Whites (multivariable-adjusted β±SE 5.0±1.4 ms in men and 6.6±0.9 ms in women, both P<0.0006). QT interval was shorter in Asian men (β±SE -6.2±1.2 ms, P<0.0001) and longer in Asian women (β±SE 3.6±0.9 ms, P=0.02) compared to White men and women, respectively. Asians had greater odds of having ECG left ventricular hypertrophy (LVH) compared with Whites (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.36-9.35 for men, OR 1.93, 95% CI 1.35-2.76 for women, both P<0.02). Over a mean follow-up of 11±3 years in Framingham and 8±3 years in Singapore, mortality rates were 24.5 and 13.4 per 1000 person-years among Whites and Asians, respectively. In Cox models, the presence of LVH had a greater effect on all-cause mortality in Asians compared with Whites (hazard ratio [HR] 2.66, 95% CI 1.83-3.88 vs HR 1.30, 95% CI 0.90-1.89, P for interaction=0.02). Conclusion: Our findings from two large community-based cohorts show prominent race differences in ECG characteristics between Whites and Asians, and also suggest a differential association with mortality. These differences may carry implications for race-specific ECG reference ranges and cardiovascular risk.
KW - Electrocardiography
KW - Epidemiology
KW - Left ventricular hypertrophy
KW - Mortality
KW - Race
UR - http://www.scopus.com/inward/record.url?scp=84991520304&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84991520304&partnerID=8YFLogxK
U2 - 10.1161/JAHA.115.002956
DO - 10.1161/JAHA.115.002956
M3 - Article
C2 - 27016575
AN - SCOPUS:84991520304
SN - 2047-9980
VL - 5
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 3
M1 - e002956
ER -