title: Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States: Insights From the Echocardiographic Study of Latinos.
abstract: BACKGROUND
  Population-based estimates of cardiac dysfunction and clinical heart failure (HF) remain undefined among Hispanics/Latino adults.
  
  
  RESULTS
  Participants of Hispanic/Latino origin across the United States aged 45 to 74 years were enrolled into the Echocardiographic Study of Latinos (ECHO-SOL) and underwent a comprehensive echocardiography examination to define left ventricular systolic dysfunction (LVSD) and left ventricular diastolic dysfunction (LVDD). Clinical HF was defined according to self-report, and those with cardiac dysfunction but without clinical HF were characterized as having subclinical or unrecognized cardiac dysfunction. Of 1818 ECHO-SOL participants (mean age 56.4 years; 42.6% male), 49.7% had LVSD or LVDD or both. LVSD prevalence was 3.6%, whereas LVDD was detected in 50.3%. Participants with LVSD were more likely to be males and current smokers (all P<0.05). Female sex, hypertension, diabetes mellitus, higher body mass index, and renal dysfunction were more common among those with LVDD (all P<0.05). In age-sex adjusted models, individuals of Central American and Cuban backgrounds were almost 2-fold more likely to have LVDD compared with those of Mexican backgrounds. Prevalence of clinical HF with LVSD (HF with reduced EF) was 7.3%; prevalence of clinical HF with LVDD (HF with preserved EF) was 3.6%. 96.1% of the cardiac dysfunction seen was subclinical or unrecognized. Compared with those with clinical cardiac dysfunction, prevalent coronary heart disease was the only factor independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4).
  
  
  CONCLUSIONS
  Among Hispanics/Latinos, most cardiac dysfunction is subclinical or unrecognized, with a high prevalence of diastolic dysfunction. This identifies a high-risk population for the development of clinical HF.
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Hardik
authors.initials: H
authors.lastname: Mehta
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Anderson
authors.initials: A
authors.lastname: Armstrong
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Katrina
authors.initials: K
authors.lastname: Swett
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Barry
authors.initials: B
authors.lastname: Hurwitz
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Shrikant
authors.initials: S
authors.lastname: Bangdiwala
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Rupal
authors.initials: R
authors.lastname: Dadhania
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: William
authors.initials: W
authors.lastname: Arguelles
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Marston
authors.initials: M
authors.lastname: Youngblood
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Spevack
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Greg A
authors.initials: GA
authors.lastname: Talavera
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Ajit
authors.initials: A
authors.lastname: Raisinghani
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.).
authors.forename: Robert
authors.initials: R
authors.lastname: Kaplan
authors.affiliation: From the Department of Medicine, Section on Cardiovascular Medicine and Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (H.M., K.S., R.D., D.W.K., C.J.R.); Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.A., J.L.); Department of Medicine and Cardiology, Northwestern University, Chicago, IL (S.J.S.); Department of Family Medicine and Public Health, Division of Preventive Medicine (M.A.A.), and Division of Cardiovascular Medicine (A.R.), University of California at San Diego; Department of Psychology, University of Miami (B.H., W.A., N.S.); Departments of Biostatistics, University of North Carolina, Chapel Hill (S.B., M.Y.); Department of Medicine, University of Illinois at Chicago (M.L.D.); Department of Epidemiology and Population Health, Albert Einstein School of Medicine, Bronx, NY (D.S., R.K.); and Department of Public Health, San Diego State University, CA (G.A.T.). crodrigu@wakehealth.edu.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000503:physiopathology; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D013599:Systole; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Hispanics; diastolic dysfunction echocardiography; echocardiography; heart failure; systolic dysfunction