Heart failure: treatment and ethnic origin

Wrigley

et al. 2011

Circ: Heart Failure

Background— Endothelial dysfunction is implicated in the pathophysiological features of heart failure (HF), and ethnic differences in the presentation of cardiovascular disease are evident, with an excess seen among South Asians (SAs). However, data on ethnic differences in endothelial function in HF are limited. Methods and Results— In a cross-sectional study, we recruited 128 subjects with systolic HF: 50 SAs, 50 whites, and 28 African Caribbeans (ACs). In addition, SAs with systolic HF were compared with 40 SAs with coronary artery disease without HF (“disease controls”) and 40 SA healthy controls. Macrovascular endothelial function was assessed by measurement of flow-mediated dilation (FMD) in response to hyperemia, arterial stiffness was assessed by the pulse-wave velocity, and microvascular endothelial function was assessed by forearm laser Doppler flowmetry. CD144-expressing endothelial microparticles were measured by flow cytometry. When compared with disease controls and healthy controls, SAs with HF had an impaired microvascular response to acetylcholine ( P =0.001) and reduced FMD ( P <0.001). In comparing ethnic groups, SAs with HF had an impaired response to acetylcholine (123±95.5%) compared with whites (258±156%) and ACs (286±173%, P <0.001 for both). Whites had a higher FMD (8.49±4.63%) than SAs (4.76±4.78%, P <0.001) and ACs (4.55±3.56%, P =0.01). No difference in endothelial-independent response was observed between study groups or in pulse-wave velocity. Ethnicity remained associated with microvascular endothelial function even after adjustment for age, presence of hypertension and diabetes mellitus, blood pressure, and glucose levels ( P =0.003). There were no differences in numbers of endothelial microparticles. Conclusions— The SAs with HF have impaired microvascular and macrovascular endothelial function but preserved arterial elastic properties. Significant ethnic differences in endothelial function are evident in subjects with HF, with ethnicity being associated with microvascular endothelial dysfunction in this disorder.

Section: Discussionmentioning

confidence: 99%

Ethnic Differences in Macrovascular and Microvascular Function in Systolic Heart Failure

Wrigley

et al. 2011

Circ: Heart Failure

“…Although 25% of adults in that local population were of South Asian ethnicity, suggesting a lower overall hospitalisation rate for South Asians, a reanalysis of these data in relation to census estimates found that elderly South Asians aged between 60 and 79 years had a fivefold higher risk of presenting with heart failure than their white counterparts. 29 Similarly, Blackledge et al 26 found that South Asians had higher age adjusted admission rates for heart failure in Leicestershire than white patients, again generally presenting at a younger age. Neither study could, however, fully exclude ethnic specific biases in referral rates or in diagnosing heart failure.…”

Section: Differences With Ethnicitymentioning

confidence: 96%

Ethnic differences in the prevalence and aetiology of left ventricular systolic dysfunction in the community: the Harrow heart failure watch

Galasko

Senior²,

Lahiri³

2005

Heart

Objective: To assess ethnic differences in the prevalence and aetiology of left ventricular systolic dysfunction (LVSD) in the community. Design: Community cohort study. All patients underwent echocardiography and those found to have LVSD underwent myocardial perfusion imaging with or without coronary angiography to diagnose underlying coronary artery disease (CAD). Setting: Seven representative general practices in Harrow, UK, a community hospital, and a local district general hospital. Patients: 1392 patients > 45 years old randomly selected from the computer records of seven general practices. Main outcome measures: The prevalence and aetiology of LVSD in the community, assessing differences between white and non-white populations, and the proportion of patients with LVSD with undiagnosed CAD. Results: 734 patients (53%) attended, 518 (71%) white and 216 (29%) non-white, the majority South Asian. Thirty nine patients (5.5%) had probable LVSD and 25 (3.5%) definite LVSD. No significant differences in prevalence were seen with ethnicity. CAD underlay most cases of LVSD. Non-white patients had a higher prevalence of CAD as the underlying aetiology of significant LVSD than white patients (100% v 56%, p = 0.04) and a trend towards less alcoholic cardiomyopathy. 8% of patients with LVSD had undiagnosed CAD. Conclusions: LVSD is common. White and non-white patients have a similar overall prevalence of LVSD. Non-white patients, the majority South Asians in this study, have a higher prevalence of CAD as the underlying cause for LVSD than white patients. CAD underlies most cases of LVSD in the community, although it may be undiagnosed unless formally assessed.

“…Manual analysis of these publications selected original clinical studies relevant to pathogenetic, diagnostic, prognostic and therapeutic aspects of systolic HF [LV ejection fraction (EF) 50% was used as a threshold] and included data on patients of South Asian origin identified 13 relevant (10–22). Analysis of references included in these publications identified additional seven papers (23–29).…”

Section: Search Strategymentioning

confidence: 99%

“…Elderly South Asians aged between 60 and 79 years have a five‐fold higher risk of presenting with HF at hospital than their white counterparts (27). However, despite their younger age South Asians had 55–60% more hospital admissions compared with the white group (11).…”

Section: Hospital Admissionsmentioning

confidence: 99%

Systolic heart failure in South Asians

International Journal of Clinical Practice

Lip

Gill

2011

Heart failure (HF) is a common condition leading to an unfavourable prognosis and impaired quality of life. In this review, we provide an overview of published literature on possible epidemiological and pathophysiological differences between patients with systolic HF of South Asian origin and those from other ethnic groups (mainly White). Systolic HF tends to manifest earlier among South Asians and with frequent hospital admissions. However, survival for such patients appears to be significantly better compared with the White group, which might be associated with different patterns of HF. For example, this could be attributed to a lower prevalence of left ventricular systolic dysfunction in South Asian subjects. Indeed, the high prevalence of hypertension and diabetes among South Asians may predispose to diastolic HF with preserved systolic function. In addition, because of underrepresentation of South Asians in clinical trials, there are little data on optimal management of this ethnic group.