Rey P. Vivo, MD; Selim R. Krim, MD; Cihan Cevik, MD; Ronald M. Witteles, MD

Disclosures

J Am Coll Cardiol. 2009;53(14):1167-1175. 

In This Article

Abstract and Introduction

Abstract

Although large-scale heart failure (HF) studies in Hispanic Americans are lacking, some compelling data indicate that they are a particularly vulnerable population and underscore the need for further research. Hispanics comprise the largest and fastest-growing ethnic group in the U.S., in whom the impact of this burgeoning public health problem may be magnified. Current data show that Hispanics with HF are more likely to be younger and underinsured than non-Hispanic whites. They have higher rates of readmissions but have lower in-hospital and short-term mortality rates. Epidemiologic studies demonstrate that Hispanics have excessive rates of diabetes, obesity, dyslipidemia, and metabolic syndrome. Although hypertension and ischemic heart disease are established risk factors in this ethnic group, it may be considered that insulin resistance plays a significant role in the pathogenesis of HF in Hispanics, accounting for their inordinate cardiometabolic risk burden and the growing evidence of novel metabolic risk factors for HF. Hispanics encounter multiple barriers to health care influenced by socioeconomic, linguistic, and cultural factors that, in turn, have an adverse impact on disease prognosis. Recognition of predominant risk factors and health care disparities in this population is crucial to tailoring appropriate management strategies. This review summarizes epidemiologic and clinical data on Hispanics with HF, details risk factors and health care impediments, and presents an agenda for future investigation.

Introduction

By midcentury, minorities are projected to become the majority in the U.S. Playing a central role in this demographic shift are Hispanic Americans who lead all ethnic groups in the U.S. in number and rate of population growth. Presently, 45.5 million Hispanics live in the U.S., comprising 15% of the total population. Spurred by higher birth rates and immigration, this number is expected to nearly triple to over 130 million by 2050, when it is projected that 1 of 3 U.S. residents will be Hispanic.[1] As the public health burden of heart failure (HF) continues to increase in the general population with its health care-related cost amounting to nearly $30 billion,[2] its consequences are expected to be magnified among Hispanics for 3 key reasons. Foremost, the remarkable growth in the Hispanic population is expected to present a challenge to the health care system. Second, Hispanics have a disproportionate cardiometabolic risk burden,[3] making them an important population to elucidate the association between novel metabolic risk factors and HF outcomes. Finally, they are significantly and unfavorably affected by health care disparities shaped by multiple socioeconomic, contextual, and cultural factors.[4,5]

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