Risk Factors for Heart Failure

Hispanics are uniformly affected by excessive rates of diabetes, overweight and obesity, atherogenic dyslipidemia, metabolic syndrome, and poorly controlled hypertension. The conglomeration of these conditions, including related pathophysiologic components that are emerging as novel risk factors for Heart Failure, is expected to amplify the risk of this ethnic group for Heart Failure.

Diabetes. Hispanics are nearly twice as likely to have diabetes as age-matched non-Hispanic whites. Moreover, the increase in diabetes prevalence from 2005 to 2050 is expected to be highest among Hispanics. The high prevalence of diabetes in this ethnic population has been attributed to higher rates of obesity, highly atherogenic diet consumption, and genetic susceptibility. Diabetes-related microvascular complications and mortality are higher in Hispanics than in non-Hispanic whites. In addition, diabetic Mexican Americans less frequently self-monitor their blood glucose and have poorer glycemic control than non-Hispanic whites.

Although data have shown that low socioeconomic and educational status, poor medical care access, and inability to speak English do not predict worse glycemic control in Hispanics, a recent study reported that modifiable selfmanagement behaviors, particularly higher diabetes-specific emotional distress, contribute to uncontrolled hyperglycemia in this population.

Poorly controlled diabetes predicts a higher risk of Heart Failure. The UKPDS (United Kingdom Prospective Diabetes Study) documented that every 1% incremental rise in glycated hemoglobin increased the risk for nonfatal Heart Failure by 16%. There is growing recognition of a “diabetic cardiomyopathy” that accounts for the increased risk of developing Heart Failure among diabetics in the absence of coronary artery disease (CAD), hypertension, or other known structural heart disease.

Data from MESA indicating ethnic differences in diabetesassociated LV abnormalities, wherein increased LV mass and wall thickness were completely attributable to subclinical atherosclerosis and hypertension in non-Hispanic whites but not in Hispanics, suggest a greater contribution from diabetes in the latter group.

Obesity. More Mexican-American men are overweight than their non-Hispanic white and African-American counterparts. They also have a higher proportion of abdominal fat than women. Among women, a higher percentage of Mexican Americans are overweight and obese than non-Hispanic whites. Hispanic adults (47.6%) are less likely than African Americans (51.3%) and non-Hispanic whites (66.1%) to engage in leisure-time physical activity.