New tool identifies specific risk factors for heart failure in Native American adults
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Key takeaways:
- A prognostic model identified risk factors for 5-, 10- and 28-year incident HF among Native American individuals.
- Risk factors included smoking, obesity and measures of diabetic control and kidney function.
A novel prognostic model identified risk factors including smoking, obesity, HbA1c and albuminuria as significant predictors of incident heart failure risk among Native American adults, researchers reported.
The model was developed using data from the Strong Heart Study, the largest cohort of Native American adults in the U.S., and the results were published in the Journal of the American Heart Association.
“Implementation of our proposed risk prediction scale in clinical practice can contribute to optimized risk assessment and to the development of preventive strategies to reduce heart failure events and deaths in American Indian communities and populations with a high burden of type 2 diabetes, which have been underrepresented in previous studies,” Irene Martinez-Morata, MD, PhD, researcher at Columbia University Mailman School of Public Health in New York City, said in a press release.
Native American communities experience a high burden of diabetes, hypertension, obesity and other risk factors that could impact HF risk, the researchers wrote.
Martinez-Morata and colleagues used data from the Strong Heart Study to develop an HF risk prediction model that accounts for risk factors that especially negatively affect Native American communities.
The researchers assessed measures of diabetes control and kidney damage, sociodemographic factors and HF subtypes to identify unique risk factors.
The analysis included 3,059 Strong Heart study participants (mean age, 56 years; 58% women), of whom 16.5% developed incident HF between the enrollment baseline of 1989-1991 and 2019.
The incidence rate of HF in the Strong Heart Study was twofold to threefold higher than in other U.S. cohorts such as MESA and ARIC, according to the researchers.
With high discriminative performance, the model identified the following risk factors associated with 5- and 10- year incident HF among Native American adults:
- older age (HR at 5 years = 1.79; 95% CI, 1.43-2.25; HR at 10 years = 1.68; 95% CI, 1.44-1.95);
- smoking (HR at 5 years = 2.26; 95% CI, 1.23-4.13; HR at 10 years = 2.08; 95% CI, 1.41-3.06);
- macroalbuminuria (HR at 5 years = 8.38; 95% CI, 4.44-15.83; HR at 10 years = 5.2; 95% CI, 3.42-7.9);
- microalbuminuria (HR at 5 years = 2.72; 95% CI, 1.51-4.9; HR at 10 years = 1.92; 95% CI, 1.33-2.78); and
- previous MI (HR at 5 years = 6.58; 95% CI, 2.54-17.03; HR at 10 years = 3.87; 95% CI, 2.29-6.54).
When paired with diabetes diagnosis and HbA1c, each of these risk factors remained significantly associated with incident HF out to 28 years. The C index at 28 years was 0.77 (95% CI, 0.74-0.78).
Unique risk factors varied across certain HF subtypes; however, diabetes, albuminuria and prior MI were significantly associated with all subtypes.
“American Indian communities have suffered historical injustices in exposure to contaminants, health care accessibility and other sociodemographic factors, resulting in a long history of health disparities. Thus, the documented high rates of type 2 diabetes in these communities are underlined by multiple complex factors beyond individual behaviors,” Martinez-Morata said in the release. “In addition, American Indian communities have been historically underrepresented in epidemiological research, resulting in underreporting of disease burden.”
Reference:
- Proposed risk factor tool finds heart failure rates are higher among American Indian adults. https://newsroom.heart.org/news/proposed-risk-factor-tool-finds-heart-failure-rates-are-higher-among-american-indian-adults. Published Aug. 21, 2024. Accessed Aug. 21, 2024.
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