Clinical Investigation
Congestive Heart Failure
Race/ethnic disparities in left ventricular diastolic function in a triethnic community cohort

https://doi.org/10.1016/j.ahj.2010.04.010Get rights and content

Background

Racial-ethnic disparities exist in cardiovascular risk factors, morbidity, and mortality. Left ventricular diastolic dysfunction is a predictor of mortality and of cardiovascular outcome including incident heart failure. We sought to assess whether race-ethnic differences in diastolic function exist. Such differences may contribute to the observed disparities in cardiovascular outcomes.

Methods

Two-dimensional echocardiography was performed in 760 participants (539 Hispanic, 117 non-Hispanic black, 104 non-Hispanic white) from the Cardiac Abnormalities and Brain Lesions study. Left ventricular diastolic function was assessed by standard Doppler flow profile and tissue Doppler imaging. Early (E) and late (A) transmitral diastolic flow, and mitral annulus early diastolic velocities (E′) were recorded; and E/A and E/E′ ratios were calculated.

Results

Blacks and Hispanics had higher body mass index (P = .04, P < .01), higher prevalence of hypertension (both Ps ≤ .05) and diabetes (both Ps < .01), and lower level of education (both Ps < .01) compared with whites. In age- and sex-adjusted analyses, Hispanics and blacks showed worse indices of diastolic function than whites. Hispanics had lower E/A ratio (P = .01), lower E′, and higher E/E′ (both Ps < .01) than whites, whereas blacks had lower E′ (P < .05) and a trend toward a higher E/E′ ratio (P = .09) compared with whites. These race-ethnic differences in diastolic function were attenuated in multivariate models adjusted for cardiovascular risk factors.

Conclusions

Differences in left ventricular diastolic function exist between race-ethnic groups. However, modifiable cardiovascular risk factors and sociodemographic variables, rather than intrinsic race-ethnic heterogeneity, seem to explain most of the observed differences.

Section snippets

Study population

The study cohort was derived from the Northern Manhattan Study (NOMAS), an epidemiologic study evaluating the incidence and risk factors for stroke in the population of Northern Manhattan. The study design and recruitment details regarding NOMAS have been described previously.25 From September 2005 through December 2008, NOMAS subjects >50 years old that voluntarily agreed to undergo a brain magnetic resonance imaging study and a more extensive echocardiographic evaluation including diastolic

Population characteristics

The characteristics of the study cohort (N = 760) are shown in Table I. Mean age was 70.8 ± 9.6 years, and 479 (63.0%) were women. Pairwise comparisons among the race-ethnic groups are also shown in Table I. Hispanics were significantly younger than blacks and whites (both Ps < .0001), and whites had significantly lower body mass index than Hispanics and blacks (P < .05 and P < .0001). Among cardiovascular risk factors, hypertension was significantly more prevalent in blacks than in whites

Discussion

The present study is the first to investigate differences in diastolic function among race-ethnic groups in an unselected community-based cohort. We showed that, after adjusting for age and sex, blacks and Hispanics had worse diastolic function than whites. Hispanics showed lower transmitral E/A ratio, lower E′ velocity, and higher E/E′ ratio compared with whites, whereas blacks showed significantly lower E′ septal velocity, a trend toward higher E/E′ ratio, but no differences in the E/A ratio

Disclosures

The study was supported by grants from the National Institute of Neurological Disorders and Stroke (NINDS)R01 NS36286 (PI: Dr Marco R. Di Tullio) and NS29993 (PIs: Drs Ralph L. Sacco/Mitchell S. V. Elkind).

Acknowledgements

We wish to thank Janet De Rosa, MPH, for the coordination of the study activities; Rui Liu, MD, and Michele Alegre, RDCS, for the performance and preliminary interpretation of the echocardiographic studies; and Rafi Cabral, MD, and Palma Gervasi-Franklin for their help in the collection and management of the data.

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