Racial Differences in Incident Heart Failure among Young Adults

Bibbins‐Domingo, Kirsten; Pletcher, Mark J.; Lin, Feng; Vittinghoff, Eric; Gardin, Julius M.; Arynchyn, Alexander; Lewis, Cora E.; Williams, O. Dale; Hulley, Stephen B.

doi:10.1056/nejmoa0807265

Cited by 511 publications

(434 citation statements)

References 44 publications

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“…In addition, despite a similar pattern of weight gain across all metabolic risk trajectories over time in CARDIA, we observed distinct associations between metabolic trajectories and subclinical CVD. Importantly, we observed significant race‐ and sex‐based heterogeneity in the relationship between adverse metabolic risk over 25 years and subclinical CVD: African Americans exhibited a higher LVM and poorer systolic function compared with Caucasians, potentially explaining well‐described race‐related differences in heart failure risk 35. Moreover, the well‐described protection from CVD in premenopausal women (compared with men) was attenuated with worsening metabolic trajectory.…”

Section: Discussionmentioning

confidence: 73%

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Murthy

Abbasi

Siddique

et al. 2016

JAHA

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BackgroundDespite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.Methods and ResultsIn 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a “metabolic” risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time‐dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low‐stable, low‐worsening, high‐stable, intermediate‐worsening, intermediate‐stable, and high‐worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher‐risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.ConclusionsTransitions in metabolic risk occur early in life. Obesity‐related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.

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Section: Discussionmentioning

confidence: 73%

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Murthy

Abbasi

Siddique

et al. 2016

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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“…They are 2 to 3 times more likely to develop LVH than Caucasians 138, 139. African Americans remain at higher risk to develop HF than Caucasians after adjustment for many HF risk factors 140, 141, 142.…”

Section: Obesity Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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Racial Differences in Incident Heart Failure among Young Adults

Abstract: Background-The epidemiology of heart failure (HF) in young adults is poorly understood.

Cited by 511 publications

References 44 publications

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

Transitions in Metabolic Risk and Long‐Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study

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

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

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