Heart failure—a disabling and often deadly form of heart disease—is hitting African Americans in their 30s and 40s at the same rate as Caucasians in their 50s and 60s, according to a study featured as the lead article of the March 19 issue of the New England Journal of Medicine.
One in 100 African-American men and women developed heart failure at an average age of 39, 20 times the rate in Caucasians, according to Racial Differences in Incident Heart Failure Among Young Adults. Heart failure in African Americans was associated with risk factors such as hypertension and obesity that were already present when these adults were in their 20s.
"These findings should be a wake-up call on the need for African Americans and physicians to address risk factors that can lead to heart failure. Heart failure is disproportionately hitting African Americans in the prime of their lives," said Kirsten Bibbins-Domingo, Ph.D., M.D., lead author of the study and a scholar with the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. Bibbins-Domingo is an assistant professor of medicine, epidemiology and biostatistics at the University of California, San Francisco (UCSF) and co-director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital.
Each year, heart failure—also known as congestive heart failure—affects about 5 million people in the United States and results in nearly 300,000 deaths, according to the National Heart, Lung, and Blood Institute, a part of the National Institutes of Health. Heart failure affects the heart's ability to pump blood to the lungs or oxygen-rich blood to the rest of the body and can cause debilitating fatigue, shortness of breath and, eventually, death.
Heart failure is traditionally perceived as a form of heart disease that mostly affects the elderly. The results of the study suggest, however, that heart failure can occur at much younger ages, particularly among African Americans.
Physicians and patients should be aware of the risk factors such as hypertension and obesity and work to prevent and treat these conditions, even among young adults.
"These findings illustrate the importance of identifying solutions to the social, economic, environmental and health care-related factors that contribute to persistent health disparities," said Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. "The study results also highlight the urgency of reversing the childhood obesity epidemic. Today's unhealthy children are tomorrow's unhealthy adults. We know that obese children are being diagnosed with conditions previously considered adult illnesses, such as type 2 diabetes and hypertension, and they're at higher lifetime risk for a host of serious health problems, including heart disease, stroke, diabetes, asthma and some forms of cancer. The harsh reality is that, unless we act now to reverse the epidemic of childhood obesity, we may raise the first generation of Americans who will live sicker and die younger than their parents."
This study found that each 10 mmHg increase in diastolic blood pressure (the "bottom" number) among African Americans in their 20s doubles the likelihood of developing heart failure when they are in their forties. "It doesn't matter how young a patient is—hypertension needs to be diagnosed and treated," Bibbins-Domingo said. "The longer you have uncontrolled hypertension, the greater the chance that you will develop heart failure."
Young adults are often unaware that they have hypertension, and even when aware are often untreated or undertreated. Physicians may be reluctant to treat younger adults because cardiovascular complications are perceived to be rare and far in the future. "Our study suggests that the complications of high blood pressure can occur much earlier and should serve as a reminder that current guidelines recommend identification and treatment of blood pressure regardless of the age of the patient," said Bibbins-Domingo.
The CARDIA Study—for Coronary Artery Risk Development in Young Adults—was undertaken to describe the development of risk factors for heart disease in young adults. CARDIA—funded by the National Institutes of Health—began in 1985 with 5,115 African-American and Caucasian men and women ages 18 to 30, recruited from Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif.
Resources on heart failure and hypertension are available on the National Heart, Lung, and Blood Institute's Web site:
The Harold Amos Medical Faculty Development Program (AMFDP) is celebrating 25 years of increasing diversity in medicine. The program was established to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine and who will encourage and foster the development of succeeding classes of such physicians. AMFDP is an extension of the Minority Medical Faculty Development Program. The program name was changed to honor Harold Amos, Ph.D., who was the first African American to chair a department, now the Department of Microbiology and Medical Genetics at the Harvard Medical School. He remained engaged with the program until his death in 2003. For more information, visit www.amfdp.org.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.