Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload: The ARIC Study

Miguel M. Fernandes-Silva, Amil M. Shah, Sheila Hegde, Alexandra Goncalves, Brian Claggett, Susan Cheng, Wilson Nadruz, Dalane W. Kitzman, Suma H. Konety, Kunihiro Matsushita, Thomas Mosley, Carolyn S P Lam, Barry A Borlaug, Scott D. Solomon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites. Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear. Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22% black) who underwent echocardiography between 2011 and 2013 were studied. Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66% vs. 57%), and had higher prevalence rates of obesity (46% vs. 31%), hypertension (94% vs. 80%), and diabetes mellitus (47% vs. 34%) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/ml). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p < 0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p < 0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p = 0.61, p for interaction <0.001; E/e′ ratio, β = −0.32 ± 0.06, p < 0.001, p for interaction <0.001). Conclusions These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk for heart failure compared with white Americans.

Original languageEnglish (US)
Pages (from-to)157-165
Number of pages9
JournalJACC: Heart Failure
Volume5
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Atherosclerosis
Ventricular Remodeling
Heart Failure
Heart Ventricles
Left Ventricular Dysfunction
Ventricular Pressure
Echocardiography
Diabetes Mellitus
Obesity
Hypertension

Keywords

  • arterial elastance
  • cardiac remodeling
  • hypertension
  • left ventricular hypertrophy
  • race

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fernandes-Silva, M. M., Shah, A. M., Hegde, S., Goncalves, A., Claggett, B., Cheng, S., ... Solomon, S. D. (2017). Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload: The ARIC Study. JACC: Heart Failure, 5(3), 157-165. https://doi.org/10.1016/j.jchf.2016.10.011

Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload : The ARIC Study. / Fernandes-Silva, Miguel M.; Shah, Amil M.; Hegde, Sheila; Goncalves, Alexandra; Claggett, Brian; Cheng, Susan; Nadruz, Wilson; Kitzman, Dalane W.; Konety, Suma H.; Matsushita, Kunihiro; Mosley, Thomas; Lam, Carolyn S P; Borlaug, Barry A; Solomon, Scott D.

In: JACC: Heart Failure, Vol. 5, No. 3, 01.03.2017, p. 157-165.

Research output: Contribution to journalArticle

Fernandes-Silva, MM, Shah, AM, Hegde, S, Goncalves, A, Claggett, B, Cheng, S, Nadruz, W, Kitzman, DW, Konety, SH, Matsushita, K, Mosley, T, Lam, CSP, Borlaug, BA & Solomon, SD 2017, 'Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload: The ARIC Study', JACC: Heart Failure, vol. 5, no. 3, pp. 157-165. https://doi.org/10.1016/j.jchf.2016.10.011
Fernandes-Silva, Miguel M. ; Shah, Amil M. ; Hegde, Sheila ; Goncalves, Alexandra ; Claggett, Brian ; Cheng, Susan ; Nadruz, Wilson ; Kitzman, Dalane W. ; Konety, Suma H. ; Matsushita, Kunihiro ; Mosley, Thomas ; Lam, Carolyn S P ; Borlaug, Barry A ; Solomon, Scott D. / Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload : The ARIC Study. In: JACC: Heart Failure. 2017 ; Vol. 5, No. 3. pp. 157-165.
@article{a2e3554568a64f13a9bb63f9352c8346,
title = "Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload: The ARIC Study",
abstract = "Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites. Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear. Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22{\%} black) who underwent echocardiography between 2011 and 2013 were studied. Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66{\%} vs. 57{\%}), and had higher prevalence rates of obesity (46{\%} vs. 31{\%}), hypertension (94{\%} vs. 80{\%}), and diabetes mellitus (47{\%} vs. 34{\%}) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/ml). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p < 0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p < 0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p = 0.61, p for interaction <0.001; E/e′ ratio, β = −0.32 ± 0.06, p < 0.001, p for interaction <0.001). Conclusions These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk for heart failure compared with white Americans.",
keywords = "arterial elastance, cardiac remodeling, hypertension, left ventricular hypertrophy, race",
author = "Fernandes-Silva, {Miguel M.} and Shah, {Amil M.} and Sheila Hegde and Alexandra Goncalves and Brian Claggett and Susan Cheng and Wilson Nadruz and Kitzman, {Dalane W.} and Konety, {Suma H.} and Kunihiro Matsushita and Thomas Mosley and Lam, {Carolyn S P} and Borlaug, {Barry A} and Solomon, {Scott D.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.jchf.2016.10.011",
language = "English (US)",
volume = "5",
pages = "157--165",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "3",

}

TY - JOUR

T1 - Race-Related Differences in Left Ventricular Structural and Functional Remodeling in Response to Increased Afterload

T2 - The ARIC Study

AU - Fernandes-Silva, Miguel M.

AU - Shah, Amil M.

AU - Hegde, Sheila

AU - Goncalves, Alexandra

AU - Claggett, Brian

AU - Cheng, Susan

AU - Nadruz, Wilson

AU - Kitzman, Dalane W.

AU - Konety, Suma H.

AU - Matsushita, Kunihiro

AU - Mosley, Thomas

AU - Lam, Carolyn S P

AU - Borlaug, Barry A

AU - Solomon, Scott D.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites. Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear. Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22% black) who underwent echocardiography between 2011 and 2013 were studied. Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66% vs. 57%), and had higher prevalence rates of obesity (46% vs. 31%), hypertension (94% vs. 80%), and diabetes mellitus (47% vs. 34%) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/ml). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p < 0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p < 0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p = 0.61, p for interaction <0.001; E/e′ ratio, β = −0.32 ± 0.06, p < 0.001, p for interaction <0.001). Conclusions These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk for heart failure compared with white Americans.

AB - Objectives The aim of this study was to evaluate racial differences in arterial elastance (Ea), which reflects the arterial afterload faced by the left ventricle, and its associations with cardiac structure and function. The hypothesis under study was that the left ventricle in blacks displays heightened afterload sensitivity compared with whites. Background Chronic increasing in arterial afterload may be an important trigger for left ventricular (LV) remodeling and dysfunction that lead to heart failure. Racial differences in the predisposition to heart failure are well described, but the underlying mechanisms remain unclear. Methods In total, 5,727 community-based, older ARIC (Atherosclerosis Risk In Community) study participants (22% black) who underwent echocardiography between 2011 and 2013 were studied. Results Blacks were younger (mean age 75 ± 5 years vs. 76 ± 5 years), were more frequently female (66% vs. 57%), and had higher prevalence rates of obesity (46% vs. 31%), hypertension (94% vs. 80%), and diabetes mellitus (47% vs. 34%) than whites. Adjusting for these baseline differences, Ea was higher among blacks (1.96 ± 0.01 mm Hg/ml vs. 1.80 ± 0.01 mm Hg/ml). In blacks, Ea was associated with greater LV remodeling (LV mass index, β = 3.21 ± 0.55 g/m2, p < 0.001) and higher LV filling pressures (E/e′ ratio, β = 0.42 ± 0.11, p < 0.001). These relationships were not observed in whites (LV mass, β = 0.16 ± 0.32 g/m2, p = 0.61, p for interaction <0.001; E/e′ ratio, β = −0.32 ± 0.06, p < 0.001, p for interaction <0.001). Conclusions These community-based data suggest that black Americans display heightened afterload sensitivity as a stimulus for LV structural and functional remodeling, which may contribute to their greater risk for heart failure compared with white Americans.

KW - arterial elastance

KW - cardiac remodeling

KW - hypertension

KW - left ventricular hypertrophy

KW - race

UR - http://www.scopus.com/inward/record.url?scp=85010685586&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010685586&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2016.10.011

DO - 10.1016/j.jchf.2016.10.011

M3 - Article

C2 - 28017356

AN - SCOPUS:85010685586

VL - 5

SP - 157

EP - 165

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 3

ER -