Heart Care Info - Heart Disease Prevention & Treatment

Heart Failure Prevention Is the Best Option To Stem High Costs and Disease Burden

P Desvigne-Nickens - Circulation: Cardiovascular Quality and ..., 2011 - Am Heart Assoc1. Correspondence to Patrice Desvigne-Nickens, MD, Medical Officer, Heart Failure and Arrhythmia Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 2 Rockledge Center, Room 8176, Bethesda, MD 20892. E-mail desvignp {at} ...

In this issue of Circulation: Cardiovascular Quality and Outcomes, Okin and colleagues1 report on the incidence of heart failure in a cohort of patients with hypertension enrolled in the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study. This study, an international randomized trial, demonstrated that losartan, when compared with atenolol, provided superior reduction of events in high-risk patients with hypertension and no history of heart failure before enrollment.2 Over a 5-year follow-up period, the incidence of heart failure in blacks was 7%, significantly higher than the 3.1% incidence rate found in nonblack patients. This difference persisted even when appropriately adjusted for differences such as the heavier risk factor burden, younger age, sex, renal disease, diabetes mellitus, randomized treatment, incident myocardial infarction, in-treatment QRS duration, strain and left ventricular hypertrophy as measured by ECG, and diastolic and systolic pressure. Additionally, an echocardiographic substudy demonstrated adverse differences in left ventricular structure and performance after 2 years of antihypertensive therapy in blacks compared to nonblacks.

These findings are consistent with several previous reports detailing heart failure differences in blacks, who, when receiving their diagnosis of heart failure, are younger; have greater risk factor burden; are more overweight; and are more likely to have diabetes, renal disease, less coronary disease, and higher heart failure-related hospitalization and death rates than whites.3,4 Unique in this report is that the cohort is entirely high-risk patients with hypertension. The small numbers of black participants (497) compared ...