HFrEF risk higher among men, Black adults
Click Here to Manage Email Alerts
Among older adults without HF, men and Black participants exhibited worse systolic performance during 5 years of follow-up, putting both groups at heightened risk for HF with reduced ejection fraction, researchers reported.
“The persistence of these differences in HF risk, and HFrEF risk in particular, according to race/gender group in analyses adjusting for traditional cardiovascular risk factors suggest important residual risk related to race and gender that persists into late life,” Alvin Chandra, MD, assistant professor in the department of internal medicine at UT Southwestern Medical Center, and colleagues wrote.
Chandra and colleagues analyzed data from 5,149 adults without HF at baseline who participated in the prospective ARIC study who attended the fifth study visit (2011-2013) and underwent echocardiography. The mean age of participants was 76 years, 59% were women and 20% were Black. Researchers followed participants for a median 5.5 years for incident HF and death.
The findings were published in the Journal of the American College of Cardiology.
High incidence of HF among Black men
Researchers found that male sex and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater LV wall thickness and concentricity. Those differences persisted after adjusting for CV comorbidities.
Compared with white men, Black men were more likely to develop HF during follow-up, with an HR of 2.36 (95% CI, 1.37-4.08) vs. an HR of 1.16 (95% CI, 0.89-1.51; P for interaction = .016). Black men were also more than twice as likely to develop HFrEF compared with white men, with an HR of 3.7 (95% CI, 1.72-7.95) vs. an HR of 1.55 (95% CI, 1.01-2.37; P for interaction = .039).
Black race was associated with a higher overall incidence of HF (HR for Black adults = 1.65; 95% CI, 1.07-2.53; HR for white adults = 0.76; 95% CI, 0.49-1.17), as well as higher incidence of HFrEF among men only (HR for Black men = 2.55; 95% CI, 1.46-4.44; HR for white men = 0.91; 95% CI, 0.46-1.83).
Researchers did not observe race- or sex-based differences in incident HF with preserved EF.
“Our analysis cannot address the mechanisms responsible for the gender- and race-based differences observed in this analysis,” the researchers wrote. “Indeed, both gender and race are cultural constructs as opposed to simply biologic variables. As such, they correlate with several social determinants of health, health behaviors and comorbidity severity not captured or accounted for in this analysis.”
An ‘important epidemiologic study’
In a related editorial, João D. Fontes, MD, MPH, of Pacific Cardiovascular Associates in Laguna Hills, California, and Daniele Massera, MD, MSc, of the hypertrophic cardiomyopathy program at the NYU Grossman School of Medicine, called the analysis an important epidemiologic study, adding the findings confirm the importance of cardiac remodeling and expand that knowledge to an older and more diverse population.
“Socioeconomic factors play a major role in the epidemiology of cardiovascular disease and are fundamental determinants of health disparities,” Fontes and Massera wrote. “In fact, they influence biological processes that eventually lead to clinical manifestations. Understanding the role of subclinical changes in cardiac structure and function via imaging or laboratory biomarkers has the potential to positively affect the lives of patients by influencing therapeutic interventions, clinical diagnosis, and monitoring.”
Reference:
Collapse
Click Here to Manage Email Alerts