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Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study
Aferdita Spahillari1, Sameera Talegawkar1, Adolfo Correa1
1From the Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.S., R.K.); Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC (S.T.); Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.); Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.C.); Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University, Nashville, TN (J.G.T.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (J.L.); Department of Medicine, University of Massachusetts Medical School, Worcester (J.E.F.); Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (S.D., R.V.S.); Department of Pediatrics, Children's Hospital Boston, MA (S.d.F.); Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (D.M.); Field Center, Jackson Heart Study, Jackson State University, MS (S.M.); Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, MA (K.L.T.); and Department of Medicine, Cardiovascular Medicine Division, University of Michigan, Ann Arbor (V.L.M.).
Insights
Black adults have a higher risk of heart failure (HF). Achieving ideal cardiovascular health metrics, like controlling blood pressure and glucose, significantly lowers HF risk and adverse cardiac remodeling.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) risk is disproportionately higher in Black populations within the U.S.
- Midlife cardiovascular risk factors contribute significantly to HF incidence.
Purpose of the Study:
- To evaluate the association between Life's Simple 7 (LS7) ideal cardiovascular health metrics and incident heart failure (HF) in a Black population.
- To examine the relationship between LS7 metrics and cardiac structure/function.
Main Methods:
- Analysis of 4195 Black participants in the Jackson Heart Study (JHS) from 2000-2004.
- Assessment of LS7 metrics including blood pressure, glucose control, physical activity, and smoking.
- Cardiac magnetic resonance imaging used to evaluate left ventricular structure and function in a subset of participants (n=1188).
Main Results:
- Individuals with 3 or more LS7 ideal factors showed significantly lower incident HF risk (47% and 61% reduction for ≥4 factors).
- Elevated blood pressure, physical inactivity, smoking, and impaired glucose control were independently associated with increased HF risk.
- Ideal levels of blood pressure, body mass index, glucose control, and nonsmoking were linked to reduced adverse cardiac remodeling.
Conclusions:
- Midlife cardiovascular risk factors, including elevated blood pressure, physical inactivity, smoking, and poor glucose control, are key targets for heart failure prevention in Black individuals.
- Intensified prevention strategies focusing on these modifiable risk factors are crucial for reducing HF incidence in this population.
Background:
The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States.
Methods And Results:
We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; P<0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; P=0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; P=0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; P=0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; P<0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; P<0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance.
Conclusions:
Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
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