Heart failure rate for younger blacks called alarming

The Baltimore Sun

Young African-Americans are 20 times as likely as whites to develop heart failure, according to a new study published today. The deadly illness strikes one in every 100 blacks under the age of 50.

"We usually thought of heart failure as a disease of older people, but that's based on studies by mostly white participants," said Dr. Kirsten Bibbins-Domingo, an assistant professor at the University of California, San Francisco and the study's lead author. "The rates we're seeing of blacks in their 30s and 40s are similar to the rates you will see of whites in their 60s and 70s."

Researchers and cardiology specialists called the findings alarming and a call to action. The scientific community should step up its research on the risk factors and design clinical trials to study specialized treatment for black patients, they said.

The findings also should come as a wake-up call to young African-Americans to eat healthier and exercise. And health officials should launch prevention and education efforts as early as high school, they said.

"It's scary," said Dr. Mandeep R. Mehra, chief of cardiology at the University of Maryland Medical Center. "I think one could describe this in many ways as an epidemic in the young African-American patient, and really, it calls for structured health care efforts in the patient."

While medical experts have known for years of racial disparities in cardiac illnesses, researchers say this study is the first to examine young people with heart failure, in which a weakened heart can't pump blood to all the places in the body that need it.

The data do not reveal why blacks are more likely to develop heart failure. Experts believe genetic differences, blacks' higher rates of hypertension and obesity, and lack of access to health care all play a role. But they say more research is needed to pinpoint the causes of the disparity and develop methods to attack it.

The findings, published in the New England Journal of Medicine, come from an analysis of a 20-year study of 5,115 black and white men and women under 50. The Coronary Artery Risk Development in Young Adults Study began in 1985 with healthy participants between the ages of 18 and 30 recruited from four sites across the country. It was conducted by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health.

By the end of the study, 27 men and women had developed heart failure; all but one was black. Five of the black patients had died.

About 5 million people in the United States have heart failure, and it results in about 300,000 deaths a year. The leading causes of heart failure are coronary artery disease, high blood pressure and diabetes.

The study's researchers found that black patients who were obese or had low levels of "good" cholesterol were more likely to develop heart disease. Those with hypertension or kidney disease were also at risk.

Bibbins-Domingo said that the most important risk factor found in the study was high blood pressure, particularly diastolic blood pressure (the bottom number in a blood pressure reading, measured in millimeters of mercury). The study found that an increase of 10 millimeters of mercury in diastolic blood pressure among blacks in their 20s doubled the likelihood of developing heart failure 10 to 20 years later.

Young people rarely know they have high blood pressure because they are less likely to go to the doctor or to have insurance, Bibbins-Domingo said. Even when high blood pressure is detected, doctors appear less likely to treat it in young people, often advising lifestyle changes without considering medication, she said.

"We can't just let our guard down and expect that the consequences are really far in the future," she said.

"The consequences of having such a chronic debilitating disease in your 30s and 40s is really devastating, not only to the individual patient, but to their family, their community and to society as a whole."

Wanda Pate, a-38-year-old respiratory therapist from Owings Mills, never suspected she had heart failure. But the mother of two young daughters had all the symptoms: fatigue, swelling and shortness of breath that made it nearly impossible to climb a flight of stairs. She suspected she had a lingering cold or pneumonia. Her doctor thought she might have an acid reflux problem and sent her to a specialist for tests.

The symptoms got worse until one day a serious dizzy spell sent her to the emergency room, where tests confirmed heart failure.

"I was devastated," Pate said. "The first week or two, and even the first month, I just cried. I couldn't believe how this was possible. It's like I went to bed, woke up one day and was in heart failure."

Pate's case is unusual in that she did not have common risk factors, such as high blood pressure. But she acknowledges that she did not always eat well and exercise.

For now, doctors are monitoring her closely, hoping that through medications they can strengthen her heart. Last summer, a surgeon placed a defibrillator in her chest, which gives energy to her heart when she needs it.

Today, Pate follows a strict diet and exercises in her living room, using workout tapes. Doctors told her not to return to her job because it involves too much manual labor. She is starting an event-planning business from her home and volunteers at her daughters' school. But she misses her career and her health.

"Some days I feel good, like 'I can do this, I can beat it'," she said. "Other days, I look at my kids and ask, 'Am I going there? Are they going to remember me?' "

Mehra, at the University of Maryland, said researchers are discovering that in addition to commonly known health risks, genetics play a role in how blacks and whites develop heart failure. More research is needed on those differences, he said.

His research has shown that black patients respond differently to medication for heart failure. They tend to need different doses of medication and at different frequencies than whites, he said. And some medicines don't work at all in black patients.

The best prevention for heart failure, however, is to have a healthy lifestyle, Mehra said. Blacks tend to be more sensitive to salt, which is associated with high blood pressure, so it is vital that young African-Americans limit their salt intake. They should also eat healthy foods rich in fish oils and antioxidants - which have been shown in some studies to promote heart health - and exercise regularly, he said.

"The rising tide of adolescent obesity suggests that this is not something that will be addressed in the future. It means we need to redouble our efforts now," said Bibbins-Domingo. "These are the risk factors sitting in our teenagers, particularly our minority teenagers. This is a wake-up call."

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