Racial Differences in Incident Heart Failure Among Young Adults

Heart failure affects about 5 million people in the United States and is responsible for 300,000 deaths per year. The Coronary Artery Risk Development in Young Adults (CARDIA) study evaluated 5,115 African-American and Caucasian men and women between 18 and 30 years of age to compare risks of heart failure in both ethnic groups. The authors concluded that incidence of heart failure in young African Americans is similar to heart-failure incidence for Caucasians in their 50s and 60s, and is 20 times higher in African Americans under 50 than in Caucasians under 50. In addition, African Americans in their 20s already suffer from risk factors for cardiac disease such as hypertension, obesity, and chronic kidney disease.

An important finding of this study is that 87 percent of the African Americans who went on to have heart failure had consistently uncontrolled or poorly controlled hypertension. Other studies examining these risk factors in younger adults have been conducted on primarily Caucasian cohorts, who do not have high rates of incident heart failure. This study's reporting of an extremely high incidence of heart failure in African Americans under 50, and of uncontrolled risk factors for future heart failure disease in so many young African Americans, call for changes in screening and treatment for heart failure and its antecedents in this population. Recent studies have shown that young people with hypertension are far less likely to be aware of their condition. Furthermore, although some have suggested that hypertension in African Americans is more difficult to control, even when treated, this has not proved to be true when therapy is initiated early and in accordance with guidelines.