Heart Failure With Preserved Ejection Fraction in African Americans

Abstract

Objectives In an entirely African-American cohort, we compared clinical characteristics, cardiac structure and function, and all cause mortality in heart failure (HF) with preserved ejection fraction (HFpEF) in relation to HF with reduced ejection fraction (HFrEF) and those without HF. Background African-Americans are at increased risk for HF. Nevertheless, there are limited phenotypic and prognostic data in African-Americans with HFpEF compared to those with HFrEF and those without HF. Methods Middle-aged African-Americans from the Jackson cohort of the Atherosclerosis Risk in Communities study (n=2,445) underwent echocardiography between 1993 and 1995. HF prevalence was available in 1,962 for whom left ventricular ejection fraction (LVEF) could be quantified. Participants with HF were categorized as having HFpEF (LVEF ≥ 50%) or HFrEF (LVEF < 50%), or no HF, with comparisons made between groups. Results HF was identified in 116 (5.9%) participants (n=85 [73%] HFpEF; n=31 [27%] HFrEF). Compared to those without HF, those with HFpEF were older, more likely to be female, had more frequent comorbidities, and concentric hypertrophy. In relation to HFrEF, those with HFpEF were more likely female, but less likely to have coronary heart disease, diabetes mellitus, chronic kidney disease, left atrial enlargement, and eccentric hypertrophy. Over a median 13.7 years of follow up, risk of death differed between groups, with age and sex adjusted hazard ratios of 1.51 (95%CI 1.01–2.25) for HFpEF vs. those without HF, and 2.50 (95%CI 1.37–4.58) for HFrEF vs. HFpEF. Conclusions In this cohort of middle-aged African-Americans, HFpEF was the most common form of HF, and was associated with a substantially better prognosis than HFrEF, but worse than those without HF.

Sex‐ and Race‐Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction

“…Our study revealed that blacks with HFpEF were on average about 10 years younger than whites with HFpEF, consistent with the observation that blacks with HFpEF present at younger ages 7. Indeed, 65% of blacks in our study were younger than 75 years, including about 40% who were younger than 65 years.…”

“…Sex and race are likely important contributors to the phenotypic heterogeneity of HFpEF, an observation stemming from subgroup analyses of registries such as Irbesartain in Patients With Heart Failure and Preserved Ejection Fraction (I‐PRESERVE),5 Acute Decompensated Heart Failure National Registry (ADHERE),6 Atherosclerosis Risk in Communities Study (ARIC),7 and the Cardiovascular Research Network 8. While these results have revealed important differences in baseline features and outcomes between men and women and whites and blacks, the generalizability of these findings have been limited by a modest number of analyzed patients, selection bias inherent to these registries, and/or geographic homogeneity.…”

Prognostic Value of Cardiopulmonary Exercise Testing in Heart Failure With Reduced, Midrange, and Preserved Ejection Fraction

“…We included LVEF as a covariate because this variable showed an inverse relationship with the studied outcomes even within HF categories (Figure S1). This approach is concordant with other reports that also included LVEF in multivariate models when evaluating outcomes in HF patients stratified by LVEF categories 30, 31. Importantly, the exclusion of LVEF from our multivariate models did not change the observed associations between CPET variables and the studied outcomes (Table S5).…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Eighty‐five percent of HFpEF patients were women. The most common comorbid conditions were hypertension and obesity in 85% and 71% of patients, respectively 143. In summary, central obesity appears to cause premature arterial stiffening and thereby to hasten the progression to HFpEF in hypertensive patients, particularly in African American women.…”

“…African Americans remain at higher risk to develop HF than Caucasians after adjustment for many HF risk factors 140, 141, 142. In a community‐based sample of middle‐aged African Americans, three quarters of ambulatory patients with HF had HFpEF 143. Eighty‐five percent of HFpEF patients were women.…”