Role of hypertension, diabetes, obesity, and race in the development of symptomatic myocardial dysfunction in a predominantly minority population with normal coronary arteries

Abstract

Background: Hypertension, diabetes, and obesity have been reported as risk factors for both vascular and myocardial disease. Myocardial disease may be manifest as systolic or diastolic dysfunction. The development of coronary artery disease frequently obscures or confounds the myocardial disease. Our purpose was to study the effect of these risk factors and race on the frequency and severity of myocardial disease in the absence of coronary artery disease.

Methods and results: We studied patients referred to the cardiac catheterization laboratory. We selected 233 patients with normal coronary arteries and excluded patients with other structural cardiac disorders and other causes of myocardial disease. Systolic function and diastolic function were determined. We gathered demographic, risk factor, clinical, and hemodynamic data on each patient. A multivariate analysis was performed to determine factors important to the development of myocardial disease in the absence of coronary artery disease. Diastolic dysfunction (44%) and systolic dysfunction (25%) were common findings. The 3 risk factors were found most often in black and Hispanic patients, but hypertension and obesity were most severe (P <.001) in black patients. Multivariate analysis indicated that a prior diagnosis of hypertension, level of systolic blood pressure, and severe obesity were the 3 factors independently associated with myocardial disease.

Conclusions: Systolic dysfunction and diastolic dysfunction are common in patients with normal coronary arteries who have hypertension, diabetes, and/or obesity. Because these risk factors are so frequent and severe in the black population, myocardial disease is significantly more common in this segment of the population.