The Natural History, Epidemiology, and Prognosis of Heart Failure in African Americans

Abstract

Heart failure is more common in African Americans and appears to be of worse severity. At the time of diagnosis, left ventricular function is more severely impaired and the clinical class is more advanced. The strongest risk factor for heart failure in African Americans appears to be hypertension, which is both more prevalent and more pathologic in African Americans. It is likely that heart failure represents an important end organ effect of hypertension. When affected by heart failure, African Americans experience a greater rate of hospitalization and may be exposed to a higher mortality risk as well. Genomic medicine has yielded a number of candidate single nucleotide polymorphisms that might contribute to the excess pathogenicity of heart failure in African Americans, but much more work needs to be done in larger cohorts. Effective therapy of heart failure must start with the recognition of the different manifestations of heart failure in African Americans. An increased awareness of the risk of hypertension followed by early and effective intervention may reduce the risk of heart failure in this population.

Preclinical Left Ventricular Diastolic Dysfunction in Metabolic Syndrome

“…It is therefore possible that residual confounding could in part account for our findings. Lastly, healthy controls in our sample were predominantly white, whereas nearly half of participants with MS were black, an important point since LV hypertrophy, 28 and diastolic dysfunction, are more prevalent among blacks. Our sample size was not powered to examine racial differences, however, the primary study results were not materially different in sensitivity analyses including only whites.…”

Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)

“…5 Potential mechanisms for worse outcomes in black patients with HF include the more malignant pathophysiology of hypertension in blacks, the higher prevalence and severity of left ventricular hypertrophy, an impaired vasodilatory response, and genetic polymorphisms. 3,4,27 Additional unrecognized differences in the pathophysiology of HF in blacks remain an alternative explanation. Disparities in health care access, along with a greater burden of socioeconomic stressors, may be associated with increased adverse events in black patients.…”

“…1–4 Elderly black Medicare patients were recently shown to have increased 30-day readmission rates for HF compared with whites. 5 However, several studies during the 1990s in the Veterans Affairs health care system 6,7 and in Medicare patients 8 demonstrated better survival in black patients with HF compared with white patients.…”

Association of African American Race with Elevated Pulmonary Artery Diastolic Pressure: Data from the Heart and Soul Study

“…11 Thus, elevated pulmonary artery diastolic pressure (a surrogate for LV filling pressure) may, in part, explain why African Americans with HF have a worse prognosis compared with patients of other racial groups. 7,20,21 The Studies of Left Ventricular Dysfunction were among the first to suggest differential HF outcomes as a function of race. 22 A post hoc analysis of the primary trial results demonstrated that mortality from HF was higher in African Americans than in Caucasians, with a 1.8-fold increase for African American men and a striking 2.4-fold increase for African American women.…”