Congestive Heart Failure
A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: The Strong Heart Study,☆☆,

https://doi.org/10.1067/mhj.2001.113223Get rights and content

Abstract

Background Although clinical congestive heart failure (CHF) is increasingly common, few data document the prevalence and correlates of underlying left ventricular (LV) systolic dysfunction (D) in population-based samples. Methods Echocardiography was used in the second Strong Heart Study (SHS) examination to identify mild and severe LVD (LV ejection fraction [EF] 40%-54% and <40%, respectively) in 3184 American Indians. Results Mild and severe LVD were more common in men than women (17.4% vs 7.2% and 4.7% vs 1.8%) and in diabetic than nondiabetic participants (12.7% vs 9.1% and 3.5% vs 1.6%). Stepwise increases were observed from participants with normal EF to those with mild and severe LVD in age (mean 60 vs 61 and 63 years, P <.001), prevalence of overt CHF (2% vs 6% and 28%) and definite coronary heart disease (3% vs 11% and 32%), systolic pressure (129 vs 135 and 136 mm Hg), serum creatinine level (0.98 vs 1.34 and 2.16 mg/dL), and log urinary albumin/creatinine level (3.2 vs 3.7 and 4.7); a negative relation was seen with body mass index (31.1 vs 31.0 and 28.4 kg/m2) (all P <.001). In multivariate analyses lower LVEFs were independently associated with clinical CHF and coronary heart disease, lower myocardial contractility, male sex, hypertension, overweight, arterial stiffening (higher pulse pressure/stroke volume) and renal dysfunction (higher serum creatinine level), higher LV mass, and lower relative wall thickness. Conclusions LVD, present in approximately 14% of middle-aged to elderly adults, is independently associated with overt heart failure and coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal target organ damage and, less consistently, with older age and diabetes. (Am Heart J 2001;141:439-46.)

Section snippets

Methods

The SHS is a population-based survey of cardiovascular risk factors and prevalent and incident cardiovascular disease in American Indians. As previously described,8, 9 members aged 45 to 74 years of 3 tribes in Arizona, 7 tribes in Oklahoma, and 3 tribes in North and South Dakota were recruited from tribal members living on reservations or (in Oklahoma) in a defined geographic area (overall participation rate 62%) for a first examination from 1989 to 1992.

The second SHS examination was

Characteristics of participants

Of 3501 participants who underwent echocardiography, 3184 (91%) had LVEF measurements needed for inclusion in the current study; excluded individuals were older (mean 60 vs 58 years) and heavier (body mass index 33.6 ± 8.6 vs 31.0 ± 6.2 kg/m2) and had worse lung function (forced expiratory volume in 1 second 73% vs 101% of predicted). Women comprised 2016 (63%) of participants; 1102 lived in Arizona, 1065 in Oklahoma, and 1017 in North and South Dakota; 1641 (52%) had diabetes and 1007 (33%)

Discussion

The current study represents the first comprehensive assessment of the prevalence and correlates of mild and severe systolic LVD in a large population-based sample of middle-aged and older American Indians. Our analyses reveal previously undocumented associations, independent of prevalent coronary heart disease or overt CHF, of systolic LVD with systemic arterial stiffening, renal dysfunction, and residence in North and South Dakota. Multivariate analyses confirmed expected associations between

Acknowledgements

We thank the Indian Health Service facilities, SHS participants, and participating tribal communities for extraordinary cooperation and involvement that made this study possible; Betty Jarvis, RN, Tauqeer Ali, MD, and Alan Crawford for study center coordination; Tauqeer Ali, MD, Helen Beaty, Joan Carter, Michael Cyl, and Neil Sikes for echocardiogram performance; and Virginia Burns for preparation of the manuscript.

References (32)

  • KKL Ho et al.

    Survival after the onset of congestive heart failure in Framingham Heart Study subjects

    Circulation

    (1993)
  • National Heart et al.

    The sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure

    (1997)
  • TA McDonough et al.

    Symptomatic and asymptomatic left ventricular systolic dysfunction in an urban population

    Lancet

    (1997)
  • J Parameshwar et al.

    Prevalence of heart failure in three general practices in north west London

    Br J Gen Pract

    (1992)
  • A Mosterd et al.

    Prevalence of heart failure and left ventricular dysfunction in the general population: the Rotterdam Study

    Eur Heart J

    (1999)
  • ET Lee et al.

    The Strong Heart Study—a study of cardiovascular disease in American Indians: design and methods

    Am J Epidemiol

    (1990)
  • Cited by (0)

    Supported in part by grants No. U01-HL41642, U01-HL41652, U01-HL41654, and R01-HL55502 from the National Heart, Lung, and Blood Institute and by grant No. M10RR0047-34 (GCRC) from the National Institutes of Health, Bethesda, Md.

    ☆☆

    This article does not represent the opinion of the Indian Health Service.

    Reprint requests: Richard B. Devereux, MD, Division of Cardiology, Box 222, New York Presbyterian Hospital, 525 E 68th St, New York, NY 10021. E-mail: [email protected]

    View full text