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Heart failure rates at young ages higher in black versus white patients, researchers find

Friday, April 10 2009 | Comments

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What's This? Black patients are more likely than white patients to experience heart failure (HF) before age 50 years, especially if they have hypertension, obesity, or systolic dysfunction as young adults, the CARDIA study indicates.

For 20 years, the incidence and predictors of HF were prospectively evaluated in 5,115 black and white people (age range at baseline, 18-30 years).  Researchers performed examinations and interviews at regular intervals and evaluated patient medical records to confirm information as needed. They also determined clinical and echocardiographic antecedents.

Throughout follow-up, 27 patients developed incident HF, leading to 5 deaths in black patients and 0 in white subjects. Significantly more black patients than white ones developed HF (26 vs 1, respectively; P=.001).

The cumulative incidence of HF ranged from 1.1% in black women and 0.9% in black men (mean age of onset, 39 years) to 0.08% in white women and 0% in white men.

Multivariate analyses indicated that in black subjects aged 18 to 30 years, diastolic blood pressure (BP; per 10 mm Hg increase: hazard ratio [HR], 2.1), body mass index (per 5.7 units increase: HR, 1.4), HDL cholesterol (per 13.3 mg/dL increase: HR, 0.6), and chronic kidney disease (HR, 19.8) were independent predictors of HF 15 years later, on average.

For example, three quarters of patients who had HF later on experienced hypertension by age 40 years.

When examining antecedents more proximal to HF onset, higher systolic and diastolic BP and diabetes presence were independently linked to HF risk. Finally, depressed systolic function on echocardiogram when the patients were aged 23 to 35 years was independently associated with HF developing 10 years later, on average.

The researchers summarized that during the study period, the incidence of HF in black participants before age 50 years was 20 times that of white subjects. They suggested that just 21 young black patients with hypertension would need to be treated to prevent 1 HF before age 50 years.

The study authors concluded that the antecedents identified in this study "could become targets for screening and interventions aimed at the prevention of HF." (Bibbins-Domingo K, et al. N Engl J Med 2009;360:1179-90.)

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