Epidemiology of Heart Failure Stages in Middle-Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study

Abstract

Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993-1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0: no risk factors; (2) Stage A: presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B: presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D: prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all-cause mortality on follow-up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow-up (median 19.0 years), 309 participants developed overt HF, 390 incurred new-onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person-years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5- to 2-fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community-based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.

Keywords: Black participants; cardiovascular disease; epidemiology; heart failure.

Figure 1. Prevalence of heart failure stages in Black people at ARIC visit 3 data for pooled sexes and by sex.

ARIC indicates Atherosclerosis Risk in Communities Study.

Figure 2. Kaplan–Meier plots for outcomes grouped by heart failure stages.

A, Incident clinical HF. B, CVD events. C, CVD death. D, All‐cause death. The numbers of subjects at risk by HF stages are noted at each time point. P values indicate the log‐rank test. Individuals with prevalent MI in Stage B were excluded for these analyses. Additionally, participants with prevalent CVD were excluded for analyses of incident CVD. Prevalent HF events at visit 5 (but after visit 3) that did not have an exact time of onset were deemed to have occurred at the midpoint between the 2 examinations for participants, which accounts for the steep change in slope between 8 and 12 y of follow‐up. CVD indicates cardiovascular disease; HF, heart failure; and MI, myocardial infarction.