Race/ethnic disparities in left ventricular diastolic function in a triethnic community cohort

Abstract

Background: Racial-ethnic disparities exist in cardiovascular risk factors, morbidity, and mortality. Left ventricular diastolic dysfunction is a predictor of mortality and of cardiovascular outcome including incident heart failure. We sought to assess whether race-ethnic differences in diastolic function exist. Such differences may contribute to the observed disparities in cardiovascular outcomes.

Methods: Two-dimensional echocardiography was performed in 760 participants (539 Hispanic, 117 non-Hispanic black, 104 non-Hispanic white) from the Cardiac Abnormalities and Brain Lesions study. Left ventricular diastolic function was assessed by standard Doppler flow profile and tissue Doppler imaging. Early (E) and late (A) transmitral diastolic flow, and mitral annulus early diastolic velocities (E') were recorded; and E/A and E/E' ratios were calculated.

Results: Blacks and Hispanics had higher body mass index (P = .04, P < .01), higher prevalence of hypertension (both Ps <or= .05) and diabetes (both Ps < .01), and lower level of education (both Ps < .01) compared with whites. In age- and sex-adjusted analyses, Hispanics and blacks showed worse indices of diastolic function than whites. Hispanics had lower E/A ratio (P = .01), lower E', and higher E/E' (both Ps < .01) than whites, whereas blacks had lower E' (P < .05) and a trend toward a higher E/E' ratio (P = .09) compared with whites. These race-ethnic differences in diastolic function were attenuated in multivariate models adjusted for cardiovascular risk factors.

Conclusions: Differences in left ventricular diastolic function exist between race-ethnic groups. However, modifiable cardiovascular risk factors and sociodemographic variables, rather than intrinsic race-ethnic heterogeneity, seem to explain most of the observed differences.