Abstract 11315: Ideal Cardiovascular Health, Cardiometabolic Remodeling, and Heart Failure in African-Americans: The Jackson Heart Study

Abstract

Background: Though African-Americans are at disproportionately high risk for heart failure (HF) and cardiometabolic disease, few studies have evaluated the association between ideal cardiovascular health metrics and cardiometabolic diseases or incident HF in African-Americans. Hypothesis: Ideal cardiovascular health is associated with adverse cardiometabolic phenotypes and incident HF. Methods: A total of 4195 African-American participants without prevalent coronary heart disease with 7 ideal cardiovascular health (ICVH) metrics measured at baseline (2000-2004) underwent evaluation by cardiac magnetic resonance (CMR; n=1188) and/or abdominal computed tomography (CT; n=2352). 3661 (87%) participants were followed for incident HF. Results: Mean age at baseline was 54.4 years (65% women). A lower composite score of ICVH at baseline was associated with greater LV hypertrophy, greater LV concentric remodeling, worse LV strain, and greater visceral and subcutaneous adipose tissue in follow-up (all P <0.0001). Ideal BMI, absence of smoking, controlled blood pressure and normoglycemia were associated with improved cardiac and adiposity phenotypes. Relative to individuals with 0-2 ideal ICVH factors, African-Americans with 3 factors had 48% lower incident HF risk (HR 0.52, 95% CI 0.35-0.75, P=0.0006) and those with ≥ 4 factors had 58% lower HF risk (HR 0.42, 95% CI 0.24-0.76, P=0.004). Of the 7 components of ICVH, non-ideal physical activity, smoking, and impaired glucose control were associated with incident HF risk. Conclusions: In African-Americans, lower ideal cardiovascular health in mid-life is associated with later adverse cardiometabolic remodeling and incident HF. Lack of physical activity, smoking and impaired glucose control are associated with incident HF risk and represent potential targets for prevention of cardiometabolic disease and HF in African-Americans.