Differences in the Incidence of Congestive Heart Failure by Ethnicity

Bahrami, Hossein; Kronmal, Richard A.; Bluemke, David A.; Olson, Jean L.; Shea, Steven; Liu, Kiang; Burke, Gregory L.; Lima, João A.C.

doi:10.1001/archinte.168.19.2138

Cited by 488 publications

(363 citation statements)

References 48 publications

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“…This general pattern is consistent with the etiology of HF that may be diagnosed with the exacerbation of symptoms and/or incidence of another condition, such as acute myocardial infarction 1, 46, 47. The significant decline in hospitalizations after HF diagnosis in Hispanic men can be interpreted with mixed implications.…”

Section: Discussionsupporting

confidence: 70%

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Dupre

et al. 2017

JAHA

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BackgroundPrior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual‐level trajectories of hospitalization in older adults with diagnosed HF.Methods and ResultsData from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non‐Hispanic white, non‐Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19–2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, −0.45 to −0.25; P<0.001) every 24 months and subsequently increased by 0.03 (95% CI, 0.02–0.05; P<0.001) thereafter. In men, there were no racial/ethnic differences in hospitalizations reported at the time of diagnosis; however, Hispanic men had significant declines in hospitalizations after diagnosis (Hispanic×time=−0.52; 95% CI, −0.99 to −0.05 [P=0.031]) followed by a sizeable increase in hospitalizations at later stages of disease (Hispanic×time2=0.06; 95% CI, 0.00–0.12 [P=0.047]). In women, hospitalizations were consistently high following their diagnosis and black women had significantly more hospitalizations throughout follow‐up than white women (black=0.28; 95% CI, 0.00–0.55 [P=0.048]). Racial/ethnic disparities varied by geography and the differences remained significant after adjusting for multiple sociodemographic, psychosocial, behavioral, and physiological factors.ConclusionsThere were significant racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF in US men and women. Racial/ethnic disparities varied by place of residence and the differences persisted after adjustment for multiple risk factors. The findings have important implications that may be crucial to planning the immediate and long‐term delivery of care in patients with HF to reduce potentially preventable hospitalizations.

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Section: Discussionsupporting

confidence: 70%

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Dupre

et al. 2017

JAHA

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“…We found that people with the APOL1 high‐risk genotypes were more likely to develop HF compared with the low‐risk genotypes. Prior studies have demonstrated that incident HF is much more common in blacks compared with whites 26, 27. While this difference in risk has primarily been attributed to the higher burden of traditional cardiovascular risk factors among blacks, perhaps risk variants in the APOL1 gene contribute as well 26, 27, 29.…”

Section: Discussionmentioning

confidence: 99%

“…Racial disparities in the incidence of CVD are well described 26, 27, 28, 29. In particular, the incidence of HF is much higher among blacks compared with whites 26, 27, 29.…”

Section: Introductionmentioning

confidence: 99%

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Association Between APOL1 Genotypes and Risk of Cardiovascular Disease in MESA (Multi‐Ethnic Study of Atherosclerosis)

Chen

Katz

Estrella

et al. 2017

JAHA

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Background APOL1 genetic variants confer an increased risk for kidney disease. Their associations with cardiovascular disease (CVD) are less certain. We aimed to compare the prevalence of subclinical CVD and incidence of atherosclerotic CVD and heart failure by APOL1 genotypes among self‐identified black participants of MESA (Multi‐Ethnic Study of Atherosclerosis).Methods and ResultsCross‐sectional associations of APOL1 genotypes (high‐risk=2 alleles; low‐risk=0 or 1 allele) with coronary artery calcification, carotid‐intimal media thickness, and left ventricular mass were evaluated using logistic and linear regression. Longitudinal associations of APOL1 genotypes with incident myocardial infarction, stroke, coronary heart disease, and congestive heart failure were examined using Cox regression. We adjusted for African ancestry, age, and sex. We also evaluated whether hypertension or kidney function markers explained the observed associations. Among 1746 participants with APOL1 genotyping (mean age 62 years, 55% women, mean cystatin C–based estimated glomerular filtration rate 89 mL/min per 1.73 m2, 12% with albuminuria), 12% had the high‐risk genotypes. We found no difference in prevalence or severity of coronary artery calcification, carotid‐intimal media thickness, or left ventricular mass by APOL1 genotypes. The APOL1 high‐risk group was 82% more likely to develop incident heart failure compared with the low‐risk group (95% confidence interval, 1.01–3.28). Adjusting for hypertension (hazard ratio, 1.80; 95% confidence interval, 1.00–3.24) but not markers of kidney function (hazard ratio, 1.86; 95% confidence interval, 1.03–3.35) slightly attenuated this association. The APOL1 high‐risk genotypes were not significantly associated with other clinical CVD outcomes.ConclusionsAmong blacks without baseline CVD, the APOL1 high‐risk variants may be associated with increased risk for incident heart failure but not subclinical CVD or incident clinical atherosclerotic CVD.

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“…The ascertainment of incident HF events in MESA has been described previously 26. Participants were followed for incident cardiovascular events from baseline through December 31, 2013.…”

Section: Methodsmentioning

confidence: 99%

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

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BackgroundSeveral markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093).ConclusionsMarkers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.

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Differences in the Incidence of Congestive Heart Failure by Ethnicity

Cited by 488 publications

References 48 publications

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Association Between APOL1 Genotypes and Risk of Cardiovascular Disease in MESA (Multi‐Ethnic Study of Atherosclerosis)

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

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