Division of Stroke, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science and the Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
J Clin Neurosci. 2024 May;123:173-178. doi: 10.1016/j.jocn.2024.03.035. Epub 2024 Apr 6.
Racial-ethnic disparities exist in the prevalence and outcomes of heart failure (HF) and are presumed to be related to differences in cardiovascular risk factor burden and control. There is little data on stroke disparities among patients with HF or the factors responsible. We hypothesized disparities in stroke prevalence exist among patients with HF in a manner not fully explained by burden of cardiovascular disease. We analyzed data from the National Health and Nutrition Examination Survey (1999-2014). Cardiovascular profiles were compared by race/ethnicity. Using survey-weighted models, effect modification of the relationship between HF and stroke by race/ethnicity was examined adjusting for cardiovascular profiles. Of 40,437 participants, 2.5 % had HF. The HF cohort had a greater proportion of White and Black participants (77 % vs 74 % and 15 % vs 12 %, respectively) and fewer participants of Hispanic ethnicity (8 % vs 14 %). Stroke was 8 times more prevalent in HF (19.6 % vs 2.3 %, <0.001). Among individuals with HF, race-ethnic differences were identified in the prevalence and mean values of vascular risk factors but were largely driven by higher rates in Black participants. There was significant interaction between HF and race/ethnicity; HF increased the odds of stroke over 7-fold in participants of Hispanic ethnicity (aOR: 7.84; 95 % CI: 4.11-15.0) but to a lesser extent in Black and White participants (Black aOR: 2.49; 95 % CI: 1.72-3.60; White aOR: 3.36; 95 % CI: 2.57-4.40). People of Hispanic ethnicity with HF have a disproportionately higher risk of stroke in a manner not fully explained by differences in vascular risk profiles.
在心力衰竭（HF）的患病率和结局方面存在种族和民族差异，据推测与心血管危险因素负担和控制方面的差异有关。关于 HF 患者中风差异以及导致这些差异的因素的数据很少。我们假设 HF 患者中风的患病率存在差异，这种差异不能完全用心血管疾病负担来解释。我们分析了 1999-2014 年全国健康和营养调查（National Health and Nutrition Examination Survey）的数据。按种族/民族比较心血管特征。使用调查加权模型，调整心血管特征后，检查 HF 与中风之间的关系是否存在种族/民族的效应修饰。在 40437 名参与者中，有 2.5%患有 HF。HF 队列中白人和黑人参与者的比例更高（分别为 77%和 15%，而 74%和 12%），西班牙裔参与者的比例较低（8%和 14%）。HF 患者中风的患病率高 8 倍（19.6%和 2.3%，<0.001）。在 HF 患者中，血管危险因素的患病率和平均值存在种族和民族差异，但主要是由于黑人参与者的比例较高。HF 和种族/民族之间存在显著的相互作用；西班牙裔参与者的 HF 使中风的几率增加了 7 倍以上（优势比[aOR]：7.84；95%可信区间[CI]：4.11-15.0），而黑人和白人参与者的程度较小（黑人 aOR：2.49；95% CI：1.72-3.60；白人 aOR：3.36；95% CI：2.57-4.40）。患有 HF 的西班牙裔人群的中风风险不成比例地升高，这种风险升高的程度不能完全用血管风险特征的差异来解释。
