Premature Cardiac Aging in South Asian Compared to Afro‐Caribbean Subjects in a Community‐Based Screening Study

Abstract

BackgroundPeople of South Asian (SAs) and African Caribbean (AC) origin have increased cardiovascular morbidity, but underlying mechanisms are poorly understood. Aging is the key predictor of deterioration in diastolic function, which can be assessed by echocardiography using E/e′ ratio as a surrogate of left ventricular (LV) filling pressure. The study aimed to assess a possibility of premature cardiac aging in SA and AC subjects.Methods and ResultsWe studied 4540 subjects: 2880 SA and 1660 AC subjects. All participants underwent detailed echocardiography, including LV ejection fraction, average septal‐lateral E/e′, and LV mass index (LVMI). When compared to ACs, SAs were younger, with lower mean LVMI, systolic blood pressure (BP), diastolic BP, and body mass index (BMI), as well as a lower prevalence of hypertension and smoking (P≤0.001 for all). In a multivariate linear regression model including age, sex, ethnicity, BP, heart rate, BMI, waist circumference, LVMI, history of smoking, hypertension, coronary artery disease, diabetes mellitus, medications, SA origin was independently associated with higher E/e′ (regression coefficient±standard error, −0.66±0.10; P<0.001, adjusted R 2 for the model 0.21; P<0.001). Furthermore, SAs had significantly accelerated age‐dependent increase in E/e′ compared to ACs. On multivariable Cox regression analysis without adjustment for E/e′, SA ethnicity was independently predictive of mortality (P=0.04). After additional adjustment for E/e′, the ethnicity lost its significance value, whereas E/e′ was independently predictive of higher risk of death (P=0.008).ConclusionsPremature cardiac aging is evident in SAs and may contribute to high cardiovascular morbidity in this ethnic group, compared to ACs.

Antihypertensive treatment in people of very old age with frailty: time for a paradigm shift?

“…Its assessment may improve with the expansion of home BP monitoring. Postprandial hypotension has shared mechanisms with orthostatic hypotension related to autonomic dysfunction, a significant negative prognosticator in older people with potential iatrogenic complications of antihypertensive treatments [15]. Similar to orthostatic hypotensive, postprandial hypotension may remain asymptomatic until cerebral flow autoregulation exhausts its autoregulatory mechanisms.…”

“…The SynABPM 1 study has shown that ambulatory BP monitoring can identify patients at high risk of reflex hypotension (hypotensive susceptibility), which may help select older patients with daytime hypotensive episodes who may benefit from relaxed BP targets to prevent falls along with considerations for comorbidities, life expectancy, cognitive decline, symptoms impairing quality of life and individual preferences [46]. Unfortunately, the health complexity posed by advanced age, frailty and co-existing comorbidities and polypharmacy makes an informed decision on optimal hypertension management difficult for both clinicians and patients [15]. Ambulatory BP monitoring and dynamic orthostatic tests should be utilized to support the decision, ideally utilizing the multidisciplinary expertise of internists, cardiologists, neurologists, and geriatricians supporting family physicians.…”