Systolic heart failure in South Asians

Shantsila, Eduard; Lip, Gregory Y.H.; Gill, Paramjit

doi:10.1111/j.1742-1241.2011.02796.x

Cited by 10 publications

(10 citation statements)

References 38 publications

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“…Compared with Caucasian populations, South Asian patients with systolic heart failure present earlier with frequent hospital admissions. Despite having high prevalence of diabetes and hypertension, they have lower mortality compared with their Caucasian counterparts …”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in acute heart failure: interaction between diabetes and impaired left ventricular ejection fraction

Allen

Chia³

et al. 2014

European J of Heart Fail

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Aim The aim of this study was to test the hypothesis that diabetes modifies the risk of mortality in acute heart failure patients, especially in patients with impaired LVEF, and that impaired LVEF in turn modifies the risk of mortality in diabetic patients. Methods and results We studied 2121 patients with acute heart failure admitted at two centres in Singapore from 1 January 2008 to 31 December 2009. The date of the last follow‐up was 31 December 2011, with a median follow‐up time (interquartile range) of 914 (442–1190) days. Cox regression was used to estimate hazard ratios for all‐cause mortality in patients with LVEF ≥50%, LVEF 30–49%, and LVEF <30% relative to diabetic status. Impaired LVEF (<50%) in the presence of diabetes substantially increased the risk of mortality compared with non‐diabetics with LVEF <50%. The adjusted hazard ratio (aHR) and 95% confidence interval (CI) for diabetic patients with an LVEF of 30–49% (1.46, 95% 1.18–1.81) was not statistically different from the aHR in non‐diabetic patients with severely impaired LVEF of <30% (1.38, 95% CI 1.09–1.75) (P = 0.644). The deleterious effects of diabetes seemed to be confined to acute heart failure patients with impaired LVEF, as the mortality rate in patients with LVEF >50% was not increased. Other clinical predictors of mortality were ageing, prior myocardial infarction, systolic blood pressure >140 mmHg, creatinine ≥250 µmol/L, haemoglobin <9.0 g/dL, and prior stroke/transient ischaemic attack. Conclusion The interaction of diabetes and impaired LVEF in acute heart failure patients significantly amplifies the deleterious effects of each as distinct disease entities.

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Section: Discussionmentioning

confidence: 99%

Predictors of mortality in acute heart failure: interaction between diabetes and impaired left ventricular ejection fraction

Allen

Chia³

et al. 2014

European J of Heart Fail

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“…In the UK, SAs have a higher risk of coronary artery disease (CAD), compared to white Europeans, but an opposite trend is observed in people of African‐Caribbean (AC) origin . Of note, excess in cardiac morbidity in SAs is evident despite adjustment for conventional cardiovascular risk factors, and they typically present with heart failure and require coronary interventions at a younger age compared to white subjects . Also, the Framingham score, which developed in the white US population, failed to predict excess in cardiovascular mortality in SAs in the UK .…”

Section: Introductionmentioning

confidence: 99%

“…7 Of note, excess in cardiac morbidity in SAs is evident despite adjustment for conventional cardiovascular risk factors, and they typically present with heart failure and require coronary interventions at a younger age compared to white subjects. 8,9 Also, the Framingham score, which developed in the white US population, failed to predict excess in cardiovascular mortality in SAs in the UK. 10,11 Initially, this was deemed attributable to lack of socioeconomic adjustment in the score.…”

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confidence: 99%

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

Shantsila

Gill

et al. 2016

JAHA

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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.

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“…Heart failure has emerged over the past several decades as a major global public health problem, with rising prevalence reported in both industrialized and developing nations alike (1)(2)(3)(4)(5)(6). In addition to the enormous costs inhuman suffering and loss of productivity, heart failure has imposed an increasingly heavy financial burden on health-care systems throughout the world.…”

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confidence: 99%