Mau Marjorie K L M, Seto Todd B, Kaholokula Joseph K, Howard Barbara, Ratner Robert E
Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MKLMM, JKK).
Hawaii J Med Public Health. 2014 Dec;73(12 Suppl 3):14-20.
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.
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.
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).
Methamphetamine use and BMI may be important modifiable risk factors associated with LVEF and may be important targets for improving HF morbidity and mortality.
心力衰竭（HF）对夏威夷原住民和其他太平洋岛民（NHOPIs）的影响尤为严重。本研究调查了2006年6月至2010年4月期间在一家三级护理医院住院的151名NHOPI HF患者中与左心室射血分数（LVEF）相关的危险因素。
纳入标准：（1）自我认定为NHOPI。（2）年龄≥21岁。（3）HF诊断定义为：（a）左心室射血分数（LVEF）≤40%或LVEF≤60%且舒张功能异常，以及（b）典型的HF体征/症状。LVEF在住院6周内通过超声心动图测量。临床指标、病史和问卷采用标准化方案进行评估。使用线性回归模型来研究LVEF的显著相关因素之间的关联，然后将这些因素整体纳入最终模型。P值<0.05被认为具有统计学意义。
151名参与者中，69%为男性，平均年龄54.3±13.5岁，血压112±20/69±15 mmHg，体重指数（BMI）36.9±9 kg/m²。25%的参与者吸烟，45%饮酒，23%报告有甲基苯丙胺使用史。临床上，72%患有高血压，49%患有糖尿病，37%有心肌梗死病史。近60%的患者LVEF为中度至重度（<35%）。较高的LVEF与女性性别和较高的BMI独立相关（P<0.04），而起搏器/除颤器和甲基苯丙胺使用与较低的LVEF独立相关（P<0.05）。
甲基苯丙胺使用和BMI可能是与LVEF相关的重要可改变危险因素，可能是改善HF发病率和死亡率的重要靶点。
