Home Hypertension Explanation of HF disparities more complicated than race

Explanation of HF disparities more complicated than race

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Clyde W. Yancy

PHILADELPHIA — While HF is more prevalent in the black population than in the white population, reasons for the disparity are more complicated than simply race, Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP, FHFSA, said during a plenary session at the Heart Failure Society of America Scientific Meeting.

There are real differences in HF risk between the black and white populations, including that black individuals have onset at an earlier age, have symptoms of greater consequence, have a higher incidence of HF, are more likely to have a nonischemic cause of HF, are more likely to have had hypertension implicated as a cause of their HF and have a greater disposition for ventricular remodeling, Yancy, vice dean of diversity and inclusion, Magerstadt Professor of Medicine, professor of medical social sciences and chief of the division of cardiology at Northwestern University Feinberg School of Medicine, associate director of Bluhm Cardiovascular Institute, Northwestern Memorial Hospital and past president of the American Heart Association, said.

One problem, he said, is that black Americans have low rates of meeting the seven ideal CV health behaviors labeled as Life’s Simple 7 by the AHA.

“There has clearly been demonstrated a cluster of the absence of these health variables in African Americans and Hispanics,” Yancy said. “This may predispose these groups to disease.”

Also of note, he said, is that ventricular abnormalities appear to disproportionately affect black individuals. “When adjusted for the duration and burden of hypertension, there is still an excess signal of ventricular thickness and increased ventricular mass, and the response to this is exaggerated and more deleterious in African Americans,” he said.

Researchers have established that nitric oxide is important to CV health, and the absence of it leads to oxidative stress, which affects protein signaling, Yancy said, noting that there are genetic polymorphisms that impede the response to nitric oxide, and “the absence of European ancestry is a defining characteristic” of those with them.

“There are differences in nitric oxide homeostasis, differences in the confluence or absence of nitric oxide and differences in response to a nitric oxide donor and antioxidant therapy, and differences in single nucleotide polymorphisms that appear to be associated with heart failure,” he said.

He also noted that “we’re learning that things to which we respond in our environment may have an impact on our health and our burden of disease. That means we can talk about epigenetics, where environmental stimuli, aging and diet are associated with DNA mechanisms that in turn drive protein expression.”

Consumption of frozen and processed foods, common in socioeconomically disadvantaged areas, is a problem because they are elevated in inorganic phosphate, he noted.

He mentioned that researchers have identified that high levels of fibroblast growth factor-23 confer “a striking increase in the association with heart failure, and we’ve identified a 63% increased risk in the presence of heart failure when we see hypertension and FGF-23.”

Individuals in communities with diets high in inorganic phosphates have increased upregulation of FGF-23, which confers cardiac hypertrophy worsened by chronic renal disease, Yancy said.

“To answer the question of ‘is everyone the same,’ I would answer without hesitancy that the answer is no, but is it because of race?” Yancy said. “Perhaps it is because of the unusual epidemiology currently described by race. We believe that epigenetics and exposure to the exposome further differentiates the expression of disease. Race as a biological construct is a non-sequitur.” – by Erik Swain

Reference:

Yancy CW. Plenary Session: Independence from Heart Failure: Awareness, Empathy and Activism. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 13-16, 2019; Philadelphia.

Disclosure: Yancy reports no relevant financial disclosures.

Clyde W. Yancy

PHILADELPHIA — While HF is more prevalent in the black population than in the white population, reasons for the disparity are more complicated than simply race, Clyde W. Yancy, MD, MSc, MACC, FAHA, MACP, FHFSA, said during a plenary session at the Heart Failure Society of America Scientific Meeting.

There are real differences in HF risk between the black and white populations, including that black individuals have onset at an earlier age, have symptoms of greater consequence, have a higher incidence of HF, are more likely to have a nonischemic cause of HF, are more likely to have had hypertension implicated as a cause of their HF and have a greater disposition for ventricular remodeling, Yancy, vice dean of diversity and inclusion, Magerstadt Professor of Medicine, professor of medical social sciences and chief of the division of cardiology at Northwestern University Feinberg School of Medicine, associate director of Bluhm Cardiovascular Institute, Northwestern Memorial Hospital and past president of the American Heart Association, said.

One problem, he said, is that black Americans have low rates of meeting the seven ideal CV health behaviors labeled as Life’s Simple 7 by the AHA.

“There has clearly been demonstrated a cluster of the absence of these health variables in African Americans and Hispanics,” Yancy said. “This may predispose these groups to disease.”

Also of note, he said, is that ventricular abnormalities appear to disproportionately affect black individuals. “When adjusted for the duration and burden of hypertension, there is still an excess signal of ventricular thickness and increased ventricular mass, and the response to this is exaggerated and more deleterious in African Americans,” he said.

Researchers have established that nitric oxide is important to CV health, and the absence of it leads to oxidative stress, which affects protein signaling, Yancy said, noting that there are genetic polymorphisms that impede the response to nitric oxide, and “the absence of European ancestry is a defining characteristic” of those with them.

“There are differences in nitric oxide homeostasis, differences in the confluence or absence of nitric oxide and differences in response to a nitric oxide donor and antioxidant therapy, and differences in single nucleotide polymorphisms that appear to be associated with heart failure,” he said.

He also noted that “we’re learning that things to which we respond in our environment may have an impact on our health and our burden of disease. That means we can talk about epigenetics, where environmental stimuli, aging and diet are associated with DNA mechanisms that in turn drive protein expression.”

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Consumption of frozen and processed foods, common in socioeconomically disadvantaged areas, is a problem because they are elevated in inorganic phosphate, he noted.

He mentioned that researchers have identified that high levels of fibroblast growth factor-23 confer “a striking increase in the association with heart failure, and we’ve identified a 63% increased risk in the presence of heart failure when we see hypertension and FGF-23.”

Individuals in communities with diets high in inorganic phosphates have increased upregulation of FGF-23, which confers cardiac hypertrophy worsened by chronic renal disease, Yancy said.

“To answer the question of ‘is everyone the same,’ I would answer without hesitancy that the answer is no, but is it because of race?” Yancy said. “Perhaps it is because of the unusual epidemiology currently described by race. We believe that epigenetics and exposure to the exposome further differentiates the expression of disease. Race as a biological construct is a non-sequitur.” – by Erik Swain

Reference:

Yancy CW. Plenary Session: Independence from Heart Failure: Awareness, Empathy and Activism. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 13-16, 2019; Philadelphia.

Disclosure: Yancy reports no relevant financial disclosures.

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