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Senior Citizen Health & Medicine
Diabetes, High Blood Pressure Trump Race in Causing
Heart Failure Among Older Americans
African-Americans have more heart failure because
they have more diabetes, hypertension
 March 27, 2007 – African-Americans have a much
higher rate of heart failure than other races and the reason seems to be
they are much more likely to suffer with diabetes and high blood
pressure. A new study of older Americans finds that if you exclude these
two risk factors the difference in heart failure among races disappears.
The cardiologists at John Hopkins conclude that
diabetes and high blood pressure, two conditions rooted in genetics and
environmental surroundings, play a much greater role than race alone in
determining who is mostly likely to develop heart failure.
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Experts say that racial disparities have long been
known to exist in who actually develops risk factors for the condition,
with African-Americans nearly twice as likely to be diagnosed with
diabetes and more than a third as likely to have high blood pressure
than Caucasian Americans.
But researchers have only now determined the
precise role played by race in comparison to other risk factors,
including socio-economic factors, age, gender, smoking, family history,
and other health problems, as well as diabetes and hypertension.
The Hopkins team will present its findings today in
New Orleans at the American College of Cardiology’s annual Scientific
Sessions in New Orleans.
In the study, researchers monitored nearly 7,000
men and women, age 45 to 84, of different ethnic backgrounds and with no
existing symptoms of heart disease. African-Americans developed heart
failure at significantly higher rates (4.6 cases per 1,000 per year)
than all other races, including Hispanics and Caucasians. Their rate was
almost five times that of Chinese Americans (1 case per 1,000 per year)
and almost twice that of Caucasians (2.4 cases per 1,000 per year).
However, these apparent risk differences among
races almost disappeared (dropping from twice as likely, a significant
difference, to no more than one-and-a-half times as likely, an
insignificant difference) when researchers used statistical techniques
to exclude the two traditional risk factors for heart disease.
“When all major factors are taken into account, the
differences between races for heart failure largely evaporate in the
absence of diabetes and hypertension among African-Americans,” says
senior study investigator João Lima, M.D.
According to Lima, an associate professor of
medicine and radiology at The Johns Hopkins University School of
Medicine and its Heart Institute, these early results add to other
interesting findings from the so-called Multiethnic Study of
Atherosclerosis (MESA).
The study, started in 2001, is monitoring its
ethnically diverse participants for six to eight years to see who
develops heart failure and who does not. It is the first large-scale
analysis of racial or ethnic differences in heart function. So far, 79
study participants have developed congestive heart failure.
Other results presented at the meeting showed
differences among races in heart strain, or contraction, which may
contribute to disparities in heart failure, albeit to a lesser extent.
Indeed, African-American hearts were found to contract less strongly
than those of Hispanic, Caucasian or Chinese-American backgrounds.
Lima cautions, however, that much remains to be
understood about the root causes of racial disparities and how to fix
them.
He points out that while African Americans are at
much higher risk of heart failure, there is no similarly higher number
for risk of suffering heart attack, which, like diabetes and
hypertension, often leads to heart failure. Each year, nearly 300,000
Americans die from heart failure.
In MESA, researchers found a reverse relationship,
with African Americans having the lowest rates of heart failure due to
myocardial infarct (at 25 percent), while other races had a much higher
proportion: Caucasians (40 percent), Hispanics (42 percent), and Chinese-Americans (100 percent.)
Lima says the difference could be due to successful
disease prevention efforts among all racial groups, except for African
Americans, at controlling hypertension.
“A lot of public health attention has already been
paid to getting high blood pressure under control, so it may be just
that this risk factor is under tighter control in some ethnic groups
than in others,” he says. “African-Americans are clearly getting heart
failure from causes other than heart attack.”
According to lead researcher Hossein Bahrami, M.D.,
M.P.H., the message to physicians is clear, “warding off heart failure
in African-Americans requires aggressive treatment of diabetes and
hypertension. Whether through increased screening or greater emphasis on
drug therapies, these are two risk factors that must be brought under
control.”
Bahrami, a senior cardiology research fellow at
Hopkins, says removing barriers for African- Americans to controlling
their diabetes and hypertension could be critical to reducing new cases
of heart failure. Across all ethnic groups, an estimated 550,000
Americans are diagnosed each year.
Bahrami says the team’s next steps are to determine
why different rates exist for these risk factors and the role played by
biological and environmental factors.
Editor's Notes:
Funding for this study, which is taking place in
six centers in the United States, comes from the National Heart, Lung
and Blood Institute, a member of the National Institutes of Health.
Besides Lima and Bahrami, another Hopkins
investigator involved in this study was David Bluemke, M.D., Ph.D. Study
co-authors were Richard Kronmal, Ph.D., from the University of
Washington in Seattle; Kiang Liu, Ph.D., from Northwestern University in
Chicago, and Gregory L. Burke, M.D., M.S., from Wake Forest University
in Winston-Salem, N.C.
(Presentation title: Race, ethnicity and incident
congestive heart failure, the Multiethnic Study of Atherosclerosis.)
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