Racial Disparities in Incident and Recurrent Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis

Most prior studies of cardiovascular disease (CVD) events have focused on incident events. Here, differences were analyzed by race/ethnicity in incident and recurrent CVD events in the Multi-Ethnic Study of Atherosclerosis from baseline in 2000-2002 through 2019 using joint and multivariable adjusted Cox proportional hazards modeling. Among 6814 men and women aged 45-85 years without known CVD at enrollment, during median follow-up of 17.7 years, 1206 incident and 695 recurrent CVD events occurred; 891 individuals with a nonfatal incident event were at risk for recurrent events. Rates of combined incident and recurrent CVD events among Black, White, Chinese, and Hispanic participants were 16.8, 18.6, 13.3, and 19.3 per 1000 person-years, respectively. First recurrent CVD event rates in Black, White, Chinese, and Hispanic participants were 87.7, 68.7, 78.1, and 80.7 per 1000 person-years, respectively. Revascularization rates were lower in Black compared with White participants (3.8 vs 6.4 per 1000 person-years; P < .0001). The adjusted hazard for CVD death was higher for Black than White participants (hazard ratio = 1.85; 95% CI, 1.03-3.29). In this multiethnic cohort, Black participants had a lower or similar rate of incident and recurrent CVD events, lower rate of revascularization, and higher rate of fatal CVD than did White participants.