title: The Impact of Race on the Prognosis of Preclinical Diastolic Dysfunction: A Large Multiracial Urban Population Study.
abstract: BACKGROUND
  This study was performed to assess the impact of race on the incidence of heart failure and survival in patients with preclinical diastolic dysfunction.
  
  
  METHODS
  All adults during a 5-year period with grade 1 diastolic dysfunction on echocardiogram, left ventricular ejection fraction ≥ 50%, and no diagnosis of heart failure were included in this study. Clinical endpoints were new diagnosis of heart failure (International Classification of Diseases-Ninth Revision code 428.0) and all-cause mortality. A total of 7878 patients: 20.8% non-Hispanic White, 35.8% non-Hispanic Black, and 31.0% Hispanic individuals (mean age was 68 ± 12 years, 37% men) were included in the study. Non-Hispanic Whites were older, more frequently male, and had a higher mean socioeconomic status and more antecedent myocardial infarction.
  
  
  RESULTS
  Non-Hispanic Blacks and Hispanics had more hypertension, diabetes, renal disease, and cerebrovascular disease. After a median follow-up time of 6 years, 1356 patients developed heart failure and 2078 patients died. The 10-year cumulative probabilities of heart failure and all-cause mortality were 23.9% and 32.6%, respectively. Time to incident heart failure was similar among the 3 racial groups. However, non-Hispanic Blacks (hazard ratio 0.80, P = .002) and Hispanics (hazard ratio 0.67, P < .001) experienced lower mortality compared with non-Hispanic Whites, which was confirmed on a propensity-scored sensitivity analysis.
  
  
  CONCLUSIONS
  Time to heart failure was similar among the 3 racial groups, however, non-Hispanic Whites experienced worse survival compared with non-Hispanic Blacks and Hispanics, despite their higher burden of risk factors. The reasons for worse survival in the non-Hispanic white population need to be further explored.
authors.affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Jian
authors.initials: J
authors.lastname: Shan
authors.affiliation: Department of Medicine, Jacobi Medical Center, Bronx, NY.
authors.forename: Lili
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Holmes
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Bronx, NY. Electronic address: ctaub@montefiore.org.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Taub
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D044465:White People / Q000706:statistics & numerical data*
keywords: All-cause mortality; Diastolic dysfunction; Heart failure; Race; Sex