Heart disease claims the lives of about 610,000 Americans each year — enough people that it makes sense to discuss it in more specific terms. Doing so would educate people most at risk, such as women and both men and women of color. A recent study published in Circulation: Heart Failure brings attention to the latter, suggesting that without knowing it Hispanics and Latinos are more likely to suffer from cardiac dysfunction, which can lead to heart failure.
This term can be a little confusing. The heart doesn’t stop working altogether, it just doesn’t work well. Dysfunction, as well as heart attack, high blood pressure, diabetes, and obesity can all weaken the heart’s muscles and add pressure on the heart to pump the oxygen and nutrient-rich blood cells the body needs to function properly. “The perception has been that Hispanics/Latinos are a low-risk group for cardiac dysfunction, but that is not true,” said Dr. Carlos J. Rodriguez, an associate professor of medicine and epidemiology at Wake Forest Baptist Medical Center in Winston-Salem, N.C., in a statement. On the contrary, because these racial groups experience higher rates of diabetes and obesity, their risk of cardiac troubles is also greater.
Rodriguez and his colleagues analyzed data collected from participants of Hispanic/Latino origin aged 45 to 74, all living across the United States. Each person underwent a comprehensive echocardiography examination, or a sonogram of the heart, in order to determine if they had one of two types of cardiac dysfunction: left ventricular systolic dysfunction (LVSD) or left ventricular diastolic dysfunction (LVDD). LVSD means there is reduced heart function, while LVDD means the heart function is the same, but relaxation is impaired; the left ventricle is too stiff when relaxed between beats, making it harder for enough blood to gather in its chamber.
The team also used participants’ self-reported data to identify cases of clinical heart failure.
Of the 1,818 people participating in the study, 49.7 percent had LVSD and LVDD. But LVDD was detected in 50.3 percent of participants compared to 3.6 percent of people, and mostly men, with LVSD. Women, diabetics, and those who were obese and had high blood pressure were among those with LVDD. Individuals who were from Central America and Cuba were almost two times more likely to have LVDD than Mexican-Americans, affirming the need to consider specific ethnic and gender populations when it comes to heart health.
That said, this study’s sample is more diverse than most — something study author Dr. Hardik Mehta said isn’t a coincidence. He told Medical Daily that the team wanted to include sub-populations where mortality rates due to cardiac dysfunction are highest and believes it’s one of the strengths of the study. Prior research focuses more on the general population, he said.
Dr. Shaline D. Rao, a cardiologist who specializes in heart failure at NYU Langone Medical Center, agreed. She told Medical Daily the study does a good job of including a spectrum of people and reinforces the idea that Central Americans behave differently from Mexicans, and so forth. The reasons could have to do with differences in community and genetic history.
”This study shows that there is a fair amount of disease unrecognized that we are now detecting and it gives us an objective view on how to modify undertreated risk factors,” she said.
More importantly, it shows there’s room to improve when it comes to risk factor prevention and intervention. High blood pressure and diabetes rates are still significantly higher in Hispanics and Latinos compared to other groups, and these risk factors are what cardiologists like Rao first look at when it comes to heart failure.
There’s time between the development of risk factors and when the heart starts to remodel itself to overcome them. So if you have high cholesterol, blood pressure, or kidney disease, the blood vessels start to change, impair blood flow, and the heart remodels in order to keep things going. The remodeling phase is when patients start to show symptoms of dysfunction. They vary across patients, but typically include fluid retention, bloating, shortness of breath, and fatigue.
“What happens in the heart is initially meant to be helpful,” Rao said, “but eventually that same process of trying to help the heart accommodate becomes the problem. The heart wasn’t meant to function under those conditions.” It’s best to catch patients when they’re in this transition period, when they are still feeling well, especially since early symptoms of dysfunction may not be noticed. That’s what makes it dangerous, she said.
And since participants in Mehta’s study have high blood pressure and diabetes that were not well controlled, “that speaks to a diet intervention, getting proper medication, and lifestyle changes,” Rao said.
It’s possible that this has to take place outside of a hospital setting. A separate study in Cancer Epidemiology, Biomarkers, and Prevention found Latina women were nearly twice as likely to be screened for breast cancer after community health workers visited them in their homes. It was a modest, but significant increase in screening rates, study author Dr. Gloria Coronado said.
That said, the present findings are limited. Rao calls out the use of self-reported data, noting people may interpret heart failure differently, meaning it may not be an accurate representation of the condition. And she said it also doesn’t tell us how long before a patient’s dysfunction symptoms start.
Not that Mehta and his team said this particular study would establish that time frame. It's a longitudinal study and doesn’t determine how cardiac dysfunction progresses... yet. “This is kind of a step in between,” he said. “What’s going to happen going forward will lead us to compare and provide better insight.”
For now, it’s Mehta’s hope that patients will start a conversation with their clinician about risk factor management. If LVDD dysfunction strikes more Hispanics and Latinos than other racial and ethnic groups, then it’s something both patients and doctors have to keep in mind.
“We’re not there yet, and the ultimate goal in which we collect from data for years to come,” Mehta said.
For now, Mehta should be happy to know that the study already prompts Rao to push for better education about heart disease in her community, including the benefits of very early intervention. It can be a challenging disease to control, she said, and since we don’t know the time it takes for the risk factors to lead to full-blown dysfunction, it’s still very important to pursue early treatment.
Source: Mehta H et al. Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States Insights From the Echocardiographic Study of Latinos. Circulation: Heart Failure. 2016.