March 23, 2009

Heart Failure Before Age 50 More Common in Black People

Photo of three generations of African American males

According to a new study, about 1 in 100 black men and women could develop heart failure before age 50—a strikingly higher rate than for white people. But heart failure is often preceded years earlier by risk factors that can be prevented or treated, like high blood pressure and obesity. These findings highlight the importance of targeting these risk factors in young black people.

Heart failure affects about 5 million people nationwide and leads to about 300,000 deaths each year. The condition usually develops over a decade or more, as the heart gradually loses its ability to pump enough blood through the body. Its leading causes in the U.S. are coronary artery disease, high blood pressure and diabetes. Heart failure doesn't mean that your heart has stopped or is about to stop working. However, it's a serious condition that requires medical care.

Although scientists have long known that the risk of heart failure climbs sharply with age in older adults, less is known about its incidence before age 50. To learn more about heart failure in a younger age group, scientists analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which is funded by NIH's National Heart, Lung and Blood Institute (NHLBI). CARDIA includes 5,115 black and white men and women (52% black, 55% women) who were 18 to 30 years old at the start of the study in 1985 and 1986. Physical exams were conducted every few years, and telephone interviews every 6 months for about 20 years.

In the March 19, 2009, issue of the New England Journal of Medicine, the researchers reported that heart failure developed in 27 study participants, all but 1 of whom were black. Heart failure developed at an average age of 39 among the black participants.

For black participants 18 to 30 years old, the researchers identified several independent predictors of heart failure 10 to 20 years later. These included higher blood pressure, greater body mass index (a ratio of weight to height), lower HDL (or "good" cholesterol) and chronic kidney disease.

By the tenth year of the study, when participants were between 28 and 40 years old, almost 90% of participants who later developed heart failure had untreated or poorly controlled high blood pressure. Black participants who developed heart failure were also more likely to be obese as young adults or have diabetes and chronic kidney disease. In addition, a decade before developing heart failure, they were more likely to already have systolic dysfunction, an impairment in the heart muscle's ability to contract. Heart attack, drug use and alcohol use were not associated with the risk of heart failure.

“Through this long-term study, we saw the clear links between the development of risk factors and the onset of disease one to two decades later,” said study co-author Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco. “Targeting these risk factors for screening and treatment during young adulthood could be important for heart failure prevention.”

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