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Published on: December 11, 2017
Race-related differences among patients with left ventricular dysfunction: observations from a biracial angiographic
E F Philbin1, H F Weil, C A Francis
1Section of Heart Failure & Cardiac Transplantation, Henry Ford Hospital, Detroit, Michigan, USA.
Insights
Black patients exhibit a higher burden of heart failure (HF) and left ventricular dysfunction compared to white patients. Hypertension is a key factor linked to these race-related disparities in HF epidemiology.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Investigating race-related differences in left ventricular function.
- Identifying racial disparities in medical and social conditions linked to heart failure (HF).
Purpose of the Study:
- To describe race-related differences in left ventricular function.
- To identify racial differences in coexistent medical and social conditions associated with HF development.
Main Methods:
- Prospective cohort study at two university hospitals.
- Utilized data from the Harlem-Bassett Lp(a) Study.
- Included 143 black and 313 white patients with complete data.
Main Results:
- Black patients were younger, more often female, and less educated than white patients.
- Blacks had less coronary artery disease but higher rates of hypertension, diabetes, smoking, drug, and alcohol use.
- Black patients showed higher prevalence of prior HF treatment, larger left ventricular volumes, and lower ejection fractions.
Conclusions:
- Black individuals face a significantly higher burden of left ventricular dysfunction and heart failure compared to white individuals.
- Hypertension is strongly associated with race-related differences observed in heart failure epidemiology.
- Future research should explore the interplay of race and access to quality healthcare for heart failure.
Background:
This study was designed to describe race-related differences in left ventricular function among a consecutive series of patients undergoing cardiac catheterization and to identify racial differences in coexistent medical and social conditions that are associated with the development of heart failure (HF).
Methods And Results:
This was a prospective cohort study conducted at 2 university-affiliated teaching hospitals. We used the database of the Harlem-Bassett Lp(a) Study. We included all black (N = 143) or white (N = 313) patients from the main study database for whom complete survey, laboratory, coronary angiographic, and ventriculographic data were available. "Left ventricular dysfunction" was arbitrarily defined as an ejection fraction < or =0.40 or prior pharmacologic treatment for HF. We found that blacks were younger, had a higher proportion of women, and had fewer years of formal education than their white counterparts. Coronary artery disease was less common among blacks, although this group had a higher prevalence of hypertension, diabetes, cigarette smoking, illicit drug use, and alcohol consumption. Black patients had a higher prevalence of previous treatment for HF, larger left ventricular volumes, and lower ejection fractions than white patients. Blacks with left ventricular dysfunction were more likely to have had a previous myocardial infarction or a history of hypertension compared with those without left ventricular dysfunction.
Conclusions:
Regarding left ventricular dysfunction and HF, we conclude that blacks seem to have a much higher burden of disease than whites. Our observations support prior evidence that hypertension is linked to race-related differences in the epidemiology of HF. The interaction between race and access to quality care for HF remains an important area for future investigation.
