Black and Latino individuals are less likely than their white peers to develop early-onset atrial fibrillation (EOAF), yet these individuals experience higher rates of stroke, heart failure, and mortality from AF than do white patients. To date, little has been known about this paradox, as most research into EOAF focuses on white patients.
Black and Latino individuals are less likely than their white peers to develop early-onset atrial fibrillation (EOAF), yet these individuals experience higher rates of stroke, heart failure, and mortality from AF than do white patients. To date, little has been known about this paradox, as most research into EOAF focuses on white patients. However, new research published in JAMA Network Open finds that, in black and Latino patients, family history has a link with development of EOAF.
In a cohort study of 664 patients enrolled in the University of Illinois at Chicago (UIC)'s AF registry, researchers, led by Zain Alzahrani, MD, sought to assess whether, across racial and ethnic groups, patients with EOAF had a higher rate of AF in first-degree family members than did racially and ethnically matched control patients with non-EOAF.Among the patients, 267 (40%) were white, 258 (39%) were black, and 139 (21%) were Latino. In total, 74 patients (11%) had EOAF, and 590 (89%) had non-EOAF. The prevalence of EOAF in black, white, and Latino patients was 9%, 15%, and 7%, respectively. In patients with EOAF, 46% had a family history of AF in a first-degree relative. In patients with non-EOAF, only 22% had such a family history.
Further analysis showed that the adjusted odds of a patient who had EOAF and was black (OR, 2.69; 95% CI, 1.06-6.91; P  < .001) or Latino (OR, 9.25; 95% CI, 2.37-36.23; P  =  .002) having a first-degree relative with AF were greater than those of a patient who was white (OR, 2.51, 95% CI, 1.29-4.87; P  =  .006).
“Our analysis shows that there is a genetic predisposition to EOAF in blacks and Latinos that is greater than what we see in whites,” Dawood Darbar, MD, professor of medicine and head of cardiology at the UIC College of Medicine, and one of the study’s authors, said in a statement. “I was surprised to see that even though blacks and Latinos have a lower risk of developing AF…they had similar or higher risk if there was a family history of the condition. This is telling information for practicing health care providers who, while working with patients, need to determine risk and develop preventive strategies—not just for patients, but for their families, as well.”
It will be key, wrote Darbar and colleagues, to identify first-degree family members who have a risk of AF, because these family members may warrant closer surveillance for asymptomatic AF. It is possible, they wrote, that the higher incidence of stroke observed in black and Latino patients could be linked to asymptomatic AF, so more intense surveillance of family members is likely warranted.
Genetic sequencing of AF genes from patients with EOAF may also be useful in the future; while testing for AF genes is not currently recommended, targeted sequencing in patients with EOAF could lead to improvements in management of patients’ conditions and could also enable the cascade screening of family members at risk of developing AF and adverse outcomes.
Alzahrani Z, Ornelas-Loredo A, Darbar SD, et al. Association between family history and early-onset atrial fibrillation across racial and ethnic groups. JAMA Network Open. 2018;1(5). doi: 10.1001/jamanetworkopen.2018.2497.