title: Association of modifiable risk factors and left ventricular ejection fraction among hospitalized Native Hawaiians and Pacific Islanders with heart failure.
abstract: BACKGROUND
  Heart failure (HF) disproportionately affects Native Hawaiians and Other Pacific Islanders (NHOPIs). This study examines risk factors associated with left ventricular ejection fraction (LVEF) among 151 hospitalized NHOPI HF patients enrolled at a single tertiary care hospital between June 2006 and April 2010.
  
  
  METHODS
  Enrollment criteria: (1) NHOPI by self-identification. (2) Age ≥ 21 yrs. (3) Diagnosis of HF defined: (a) left ventricular ejection fraction (LVEF) ≤ 40% or LVEF ≤ 60% with abnormal diastolic function and (b) classic HF signs/symptoms. LVEF was measured by echocardiography within 6 weeks of hospitalization. Clinical measures, medical history, and questionnaires were assessed using standardized protocols. Linear regression modeling was used to examine the association of significant correlates of LVEF, which were then included en bloc into the final model. A P-value < .05 was considered statistically significant.
  
  
  RESULTS
  Of 151 participants, 69% were men, mean age 54.3 ± 13.5 years, blood pressure 112 ± 20/69 ± 15 mmHg, and body mass index (BMI) 36.9 ± 9 kg/m(2). Twenty-five percent of participants were smokers, 45% used alcohol and 23% reported a history of methamphetamine use. Clinically, 72% had hypertension, 49% were diabetic and 37% had a prior myocardial infarction. Nearly 60% had moderate to severe LVEF (< 35%). Higher LVEF was independently associated with female sex and greater BMI (P < .04) while pacemaker/defibrillator and methamphetamine use was independently associated with lower LVEF (P < .05).
  
  
  CONCLUSIONS
  Methamphetamine use and BMI may be important modifiable risk factors associated with LVEF and may be important targets for improving HF morbidity and mortality.
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
authors.forename: Marjorie K L M
authors.initials: MK
authors.lastname: Mau
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Kaholokula
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
authors.forename: Barbara
authors.initials: B
authors.lastname: Howard
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000208:ethnology; D019969:Amphetamine-Related Disorders / Q000208:ethnology; D003920:Diabetes Mellitus / Q000208:ethnology; D004452:Echocardiography; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006333:Heart Failure / Q000208:ethnology* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology; D044468:Native Hawaiian or Pacific Islander / Q000208:ethnology*; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000208:ethnology* / Q000503:physiopathology