title: Racial differences in incident heart failure among young adults.
abstract: BACKGROUND
  The antecedents and epidemiology of heart failure in young adults are poorly understood.
  
  
  METHODS
  We prospectively assessed the incidence of heart failure over a 20-year period among 5115 blacks and whites of both sexes who were 18 to 30 years of age at baseline. Using Cox models, we examined predictors of hospitalization or death from heart failure.
  
  
  RESULTS
  Over the course of 20 years, heart failure developed in 27 participants (mean [+/-SD] age at onset, 39+/-6 years), all but 1 of whom were black. The cumulative incidence of heart failure before the age of 50 years was 1.1% (95% confidence interval [CI], 0.6 to 1.7) in black women, 0.9% (95% CI, 0.5 to 1.4) in black men, 0.08% (95% CI, 0.0 to 0.5) in white women, and 0% (95% CI, 0 to 0.4) in white men (P=0.001 for the comparison of black participants and white participants). Among blacks, independent predictors at 18 to 30 years of age of heart failure occurring 15 years, on average, later included higher diastolic blood pressure (hazard ratio per 10.0 mm Hg, 2.1; 95% CI, 1.4 to 3.1), higher body-mass index (the weight in kilograms divided by the square of the height in meters) (hazard ratio per 5.7 units, 1.4; 95% CI, 1.0 to 1.9), lower high-density lipoprotein cholesterol (hazard ratio per 13.3 mg per deciliter [0.34 mmol per liter], 0.6; 95% CI, 0.4 to 1.0), and kidney disease (hazard ratio, 19.8; 95% CI, 4.5 to 87.2). Three quarters of those in whom heart failure subsequently developed had hypertension by the time they were 40 years of age. Depressed systolic function, as assessed on a study echocardiogram when the participants were 23 to 35 years of age, was independently associated with the development of heart failure 10 years, on average, later (hazard ratio for abnormal systolic function, 36.9; 95% CI, 6.9 to 198.3; hazard ratio for borderline systolic function, 3.5; 95% CI, 1.2 to 10.2). Myocardial infarction, drug use, and alcohol use were not associated with the risk of heart failure.
  
  
  CONCLUSIONS
  Incident heart failure before 50 years of age is substantially more common among blacks than among whites. Hypertension, obesity, and systolic dysfunction that are present before a person is 35 years of age are important antecedents that may be targets for the prevention of heart failure. (ClinicalTrials.gov number, NCT00005130.)
authors.affiliation: Department of Medicine and the Division of General Internal Medicine and the UCSF Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, San Francisco, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Pletcher
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.forename: Alexander
authors.initials: A
authors.lastname: Arynchyn
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: O Dale
authors.initials: OD
authors.lastname: Williams
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hulley
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000208:ethnology* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000208:ethnology; D008297:Male; D009765:Obesity / Q000150:complications / Q000208:ethnology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018754:Ventricular Dysfunction / Q000150:complications / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American