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Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos.
Circ Heart Fail 2016; 9(4):e002733CH

Abstract

BACKGROUND

Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults.

METHODS AND RESULTS

Participants of Hispanic/Latino origin across the United States aged 45 to 74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography examination to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report, and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1818 ECHO-SOL participants (mean age 56.4 years; 42.6% male), 49.7% had LVSD or LVDD or both. LVSD prevalence was 3.6%, whereas LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all P<0.05). Female sex, hypertension, diabetes mellitus, higher body mass index, and renal dysfunction were more common among those with LVDD (all P<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost 2-fold more likely to have LVDD compared with those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared with those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4).

CONCLUSIONS

Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.

Authors+Show Affiliations

From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.). crodrigu@wakehealth.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27048764

Citation

Mehta, Hardik, 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, vol. 9, no. 4, 2016, pp. e002733.
Mehta H, Armstrong A, Swett K, et al. Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos. Circ Heart Fail. 2016;9(4):e002733.
Mehta, H., Armstrong, A., Swett, K., Shah, S. J., Allison, M. A., Hurwitz, B., ... Rodriguez, C. J. (2016). Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos. Circulation. Heart Failure, 9(4), pp. e002733. doi:10.1161/CIRCHEARTFAILURE.115.002733.
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. Circ Heart Fail. 2016;9(4):e002733. PubMed PMID: 27048764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos. AU - Mehta,Hardik, AU - Armstrong,Anderson, AU - Swett,Katrina, AU - Shah,Sanjiv J, AU - Allison,Matthew A, AU - Hurwitz,Barry, AU - Bangdiwala,Shrikant, AU - Dadhania,Rupal, AU - Kitzman,Dalane W, AU - Arguelles,William, AU - Lima,Joao, AU - Youngblood,Marston, AU - Schneiderman,Neil, AU - Daviglus,Martha L, AU - Spevack,Daniel, AU - Talavera,Greg A, AU - Raisinghani,Ajit, AU - Kaplan,Robert, AU - Rodriguez,Carlos J, PY - 2015/07/13/received PY - 2016/02/10/accepted PY - 2016/4/7/entrez PY - 2016/4/7/pubmed PY - 2016/8/2/medline KW - Hispanics KW - diastolic dysfunction echocardiography KW - echocardiography KW - heart failure KW - systolic dysfunction SP - e002733 EP - e002733 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 9 IS - 4 N2 - BACKGROUND: Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults. METHODS AND RESULTS: Participants of Hispanic/Latino origin across the United States aged 45 to 74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography examination to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report, and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1818 ECHO-SOL participants (mean age 56.4 years; 42.6% male), 49.7% had LVSD or LVDD or both. LVSD prevalence was 3.6%, whereas LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all P<0.05). Female sex, hypertension, diabetes mellitus, higher body mass index, and renal dysfunction were more common among those with LVDD (all P<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost 2-fold more likely to have LVDD compared with those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared with those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4). CONCLUSIONS: Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/27048764/Burden_of_Systolic_and_Diastolic_Left_Ventricular_Dysfunction_Among_Hispanics_in_the_United_States:_Insights_From_the_Echocardiographic_Study_of_Latinos_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.115.002733?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -