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Heart Failure in Elderly African-Americans
1College of Physicians and Surgeons of Columbia University and Department of Medicine, Harlem Hospital Center, New York, NY.
Insights
Heart failure disproportionately affects older adults, with African Americans experiencing higher risks due to hypertension and left ventricular hypertrophy. Understanding these factors is crucial for effective management and treatment strategies.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Heart failure is a significant cardiovascular disease in the elderly, impacting function, economy, and society.
- Racial disparities in heart failure morbidity, mortality, and hospitalization rates are well-documented.
- Hypertension and left ventricular hypertrophy are more prevalent in African Americans, potentially driving heart failure characteristics.
Purpose of the Study:
- To explore the determinants of heart failure in African Americans.
- To examine the role of coronary artery disease and atherosclerosis in heart failure pathogenesis within this population.
- To understand the diverse hemodynamic and functional features of ventricular dysfunction in African Americans.
Main Methods:
- Review of national surveys and epidemiologic studies.
- Analysis of risk factors including hypertension, left ventricular hypertrophy, and coronary heart disease.
- Consideration of urbanization and lifestyle impacts on atherosclerosis.
- Evaluation of diagnostic challenges in differentiating heart failure subtypes using noninvasive cardiac techniques.
Main Results:
- Hypertension and left ventricular hypertrophy are key determinants of heart failure in African Americans.
- Atherosclerosis may play an increasing role due to lifestyle changes and urbanization.
- Ventricular dysfunction presents a spectrum from diastolic to systolic dysfunction.
- Differentiating causes like hypertensive vs. ischemic cardiomyopathy can be challenging.
Conclusions:
- Racial differences in heart failure are influenced by distinct risk factor profiles.
- Effective management requires considering age, ventricular characteristics, and drug metabolism variations.
- Noninvasive diagnostic techniques are essential for accurate diagnosis and subtype differentiation.
Abstract:
Heart failure has emerged as one of the most important cardiovascular diseases in the elderly and has a major functional, economic, and social impact in older individuals. Racial differences in the morbidity and mortality, as well as in rates of hospitalization, have been reported in national surveys and epidemiologic studies. Because of the higher prevalence of hypertension and left ventricular hypertrophy in African-Americans compared to whites, these risk factors may be the principle determinants of the hemodynamic and clinical features of heart failure in African-Americans. The contribution of coronary disease with left ventricular remodeling secondary to myocardial ischemia or infarction varies among African-American populations, depending on the prevalence and impact of traditional risk factors for coronary heart disease. Atherosclerosis may play a greater role in the pathogenesis of heart failure in African-Americans as the impact of urbanization and the adoption of unhealthy lifestyles results in increased prevalence of risk factors for coronary artery disease. The hemodynamic and functional features of ventricular dysfunction in African-Americans with heart failure may range from asymptomatic diastolic dysfunction to typical systolic dysfunction. The differentiation of diastolic from systolic dysfunction, and hypertensive from ischemic cardiomyopathy, may be difficult in African-Americans and usually requires utilization of noninvasive cardiac diagnostic techniques. In addition to the type of ventricular dysfunction and the role of neurohormonal activation, consideration of age-related differences, ventricular structure and function, and variations in drug metabolism and pharmacokinetics are important.