Introduction: Diastolic dysfunction (DD) with normal ejection fraction is prevalent in the African-American population due to a higher prevalence of associated risk factors. The potential benefit of moderate to vigorous physical activity (MVPA) to prevent heart failure admissions in African-American adults with normal ejection fraction is under-researched. The purpose of this study is to investigate the associations of DD and MVPA with heart failure hospitalizations (HFH).
Hypothesis: We hypothesized that MVPA reduces the risk of HFH among African-American adults with normal ejection fraction.
Methods: We performed a prospective analysis of 2,427 African-American adults who participated in the Jackson Heart Study and who had 2D echo and physical activity data and normal ejection fraction. MVPA per week is defined as the following: poor health [[Unable to Display Character: –]] 0 minutes; intermediate health [[Unable to Display Character: –]] 1-149 minutes; and ideal health [[Unable to Display Character: –]] ≥ 150 minutes. DD is defined as using ratio of the early to late ventricular filling velocities, ratio of pulmonary venous systolic to diastolic velocities, and pulmonary venous atrial reversal velocity. We employed multiple variable logistic and cox proportional regression analyses adjusted for age, gender, BMI, smoking, hypertension, DM, COPD, CKD, and CHD to determine the associations of DD and MVPA with HFH.
Results: Of the eligible population, 1,209 (50%) have DD. There were 171 HFH. DD is associated with HFH in the crude analysis (OR=2.24, 95% CI 1.40-3.57). The association was markedly attenuated after adjusting for age (OR=1.03, CI 0.63-1.71). Intermediate and ideal health MVPA in the crude analysis were associated with lower risk of HFH (HR=0.50, 95% CI 0.35-0.71 and HR=0.18, 95% CI 0.09-0.36, respectively), and full models revealed HR=0.71, 95% CI 0.49-1.04 and HR=0.31, 95% CI 0.16-0.63, respectively. There was no interaction between physical activity level and DD on HFH.
Conclusion: In conclusion, ideal health MVPA is associated with reduced risk of HFH, whereas, intermediate health MVPA revealed a trend in risk reduction in African-American with normal ejection fraction.