March 18, 2009 -- One in 100 African-Americans will suffer heart failure in the prime of his or her life, a startling new study shows.
That's 20 times white Americans' risk of heart failure before age 50.
"Blacks in their 30s and 40s develop heart failure at rates seen in whites in their 50s and 60s," study leader Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, tells WebMD.
Bibbins-Domingo and colleagues followed 5,115 young people -- about half of them African-American, about half of them female -- who underwent regular medical exams over the first 20 years of the ongoing study. Twenty-seven study participants had heart failure at an average age of 39. All but one of them were African-American.
Study participants were 18 to 30 years old -- most in their early 20s -- when the study began in 1985-1986 in Birmingham, Ala.; Chicago; Minneapolis; and Oakland, Calif.
"It has been known for some time that blacks have more heart failure and may be slightly younger when they develop heart failure, but ours is the first study to document how high these rates are at younger ages," Bibbins-Domingo says.
Interestingly, in terms of heart disease risk, whites and African-Americans looked pretty much the same at the start of the study. When participants were in their early 20s, there was little difference in blood pressure or average body weight.
"So why were only blacks developing heart failure in our study? One possibility is blacks have higher rates of increases in blood pressure and BMI in their 20s. Although at the beginning they were similar to whites, over time the two groups began to look different, with more hypertension and obesity among blacks," Bibbins-Domingo says.
A telling statistic: Three-fourths of the African-American study participants who suffered heart failure had uncontrolled high blood pressure by age 40.
Heart Disease Screening, Treatment Lax
Don't blame the patient, warns Eric D. Peterson, MD, MPH, director of cardiovascular research at Duke University.
In an editorial accompanying the Bibbins-Domingo report, Peterson notes that African-American patients are less likely than whites to be screened for, get treatment for, or reach treatment goals for high blood pressure, high cholesterol/blood fats, and obesity.
"We have come to accept that there are care differences between African-American and white populations, but does it really matter? This study shows 20-fold higher rates of heart failure that could potentially have been avoidable. It is just striking," Peterson tells WebMD.
What makes the finding tragic, Peterson says, is that we have effective treatments for high blood pressure.
"It is not a question of needing new treatments, it is a question of getting these treatments to patients," he says. "If we did that, we could avoid many of these cases."
More Heart Disease Prevention Needed
Heart failure is only one deadly outcome of high blood pressure. There would be 7,670 fewer heart disease and stroke deaths each year if African-Americans' blood pressure was controlled as well as that of white Americans, according to a recent study by University of Rochester researcher Kevin Fiscella, MD, MPH.
"Huge numbers of African-Americans who develop heart failure are untreated, and even among those who are treated, blood pressure is not controlled," Fiscella tells WebMD. "That is a huge opportunity for beginning to make a dent in this extraordinarily high risk of heart failure."
Compounding the racial differences in blood pressure control is young age. Young people simply don't worry about their blood pressure. That can be a fatal mistake.
"If you think about heart failure as your engine wearing out, think of the damaging effect of high blood pressure over 20 years of your life," Peterson says. "These are young people who were considered to be well, yet they had this ticking time bomb of disease that would kill them."
Bibbins-Domingo, Peterson, and Fiscella all agree that the main take-home message from the study is the need for heart disease prevention.
"This is really about focusing on prevention: the lifestyle issues around moderating weight and decreasing salt intake," Bibbins-Domingo says. "Prevention is the key when talking about a very high-risk group."
And Fiscella says there's another message here as well.
"This shows the progress we have made in reducing health care disparities has been pretty dismal to date," he says.
The Bibbins-Domingo study and the Peterson editorial appear in the March 19 issue of the New England Journal of Medicine.