Heart Failure in Blacks May Signal ‘Different Disease’DALLAS
According to Dr. Clyde Yancy, a researcher at the University of Texas Southwestern Medical Center, an emerging database of genetic variations in Black Americans could explain the differences in their response to traditional heart-failure therapies.
Yancy’s research, published in last month’s issue of Current Cardiology Reports, indicates that traditional therapies are less effective among Blacks than Whites. The research also points to the possible need for unique heart-failure management strategies for African Americans.
“The distinct natural history, cause of the heart failure, prognosis and response to treatment suggest that heart failure in Blacks is likely to be a different disease,” says Yancy, associate professor of internal medicine.
Yancy says certain genetic variations could explain why traditional therapies are not effective.
“The physiology of the heart and blood vessels may differ, and there may be certain other differences that are determined by variation in genetic signals. Much work needs to be done in this area, but there is growing curiosity that a genetic basis may exist to explain some of the differences in outcomes that are seen in Black patients with heart failure,” he says.
Heart failure affects 3 percent of Black Americans, or 660,000 people, and several factors account for such high numbers. The disease occurs at an earlier age in Blacks, and hypertension, or high blood pressure, also appears to heavily affect other organs in the body resulting in an increase in stroke and kidney failure.
Results from recent clinical trials show that Blacks are twice as likely as non-Black to suffer from and die of heart failure.
“A much higher incidence of hypertension as a potential cause of heart failure in Blacks is now evident and may be associated with related alterations in medicinal responsiveness to cardiovascular treatments,” Yancy says.
To further evaluate the response to heart-failure therapies, Yancy and other investigators initiated a multicenter trial last year called the African American Heart Failure Patients trial. The study is the first prospective heart-failure trial conducted exclusively for Black patients. The researchers will evaluate the safety and efficacy of the heart failure drug BiDil.
In a study published last year, Yancy found that the beta-blocking drug carvedilol reduces the risk of death and the symptoms of mild to moderate heart failure in Black patients as well as it does in non-Black patients. Beta-blockers previously have been shown to be less effective in Blacks. This was the first study to evaluate whether race influences the response to the relatively new carvedilol as a treatment of heart failure.
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