Lifestyle Modification: How it Effects African Americans and Reduces the Risk Associated with Congestive Heart Failure By: Donnell Carson Advisor: Professor Fahringer Introduction Congestive Heart Failure (CHF), also called heart failure, is a life-threatening condition in which the heart can no longer pump enough blood to the rest of the body Heart failure is almost always a chronic, long- term condition, although it can sometimes develop suddenly Introduction This condition may affect the right side, the left side, or both sides of the heart You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes, abuse alcohol, or use cocaine Signs and Symptoms shortness of air (with cough activity, or after lying down for a while difficulty sleeping weight gain fatigue Who this Affects? According to the National Institutes of Health, about 5 million Americans have heart failure African Americans (AA) seem to have more cases of CHF, than whites (3% vs. 2 %) How CHF affects African-Americans The onset occurs at an earlier age, compared with other populations and is more commonly associated with a history of hypertension than with epicardial coronary disease severe hypertension is 3 to 7 times more prevalent in African Americans than in whites, and left ventricular hypertrophy as well as other target organ damage is more common Drugs Angiotensin-converting Vasodilators enzyme (ACE) inhibitors Beta blockers (BB) Digitalis Preparations Diuretics (Water Pills) Angiotensin II Receptor Blockers BiDil (isosorbide/hydralazine) Lifestyle Modification Diet Tobacco Use Physical activity Alcohol use Weight management Diet Obesity is increasingly recognized as a public health epidemic and modifiable risk factor for coronary heart disease (CHD) In minority communities several important dietary alterations that include increases in sodium consumption, reduced potassium consumption, and decreased calcium intake, and higher intake of dietary sodium is linked to the incidence of hypertension Diet Given that nearly 60% of all heart failure among African Americans may be due to hypertensive heart disease DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low fat diary products, and is reduced, in total and saturated fat Diet In the “Premiere” study (Svetkey et al, 2005), which included 810 randomized individuals with an average age of 50 years, of whom 62% were women, 34% were African American, 95% were overweight or obese, and 38% were hypertensive. Among the African American participants, 26% were women and 9% were men. African American women lost an average of 7 pounds over 6 months, and African American men lost an average of 10 pounds over 6 months Physical Activity The Center for Disease Control (CDC) and the American College of Sports Medicine (ACSM) recommend 30-45 minutes of moderate exercise (brisk walking), most days of the week to reduce risk factors associated with cardiovascular disease Physical Activity Improved blood pressure Increased caloric expenditure Increased HDL Decreased serum Decreased weight triglycerides Physical Activity Regular physical activity is associated with the prevention and control of virtually every known modifiable risk factor for CHF A role for exercise is clear in the primary prevention of CHF Physical Activity Studies In a study involving 18 African American women, in a rural setting (Goodwin, 2007) Three themes came from this study: Exercise is work, Exercise make you feel good, and Exercise will help you lose weight/look better Weight Management Recent evidence suggests that environmental factors may play an important role in shaping health behaviors, such as increasing physical activity African American and Native American women reported that weather (heat), lack of safety, and not having a walking partner as common environmental constraints to walking (Duncan et al, 2003) Weight Management Lighten Up a novel, church-based lifestyle education program was developed in collaboration with 133 African American women of the local faith community in Charleston, SC (Oxemann et al, 2000) Conclusion It is a know fact that African Americans have higher incidences of heart disease and high blood pressure than any other population. Lifestyle modification, especially physical activity can reduce the risk associated with CHF References Arora R, Clark L, Taylor M. Treatment of high-risk African American patients: left ventricular dysfunction, heart failure, renal disease, and post myocardial infarction. Journal of Clinical Hypertension. 2003 Jan-Feb; 5 (1 Suppl1): 26-31. Brody H, Hunt L. BiDil: Assessing a race-based pharmaceutical. Annals of Family Medicine. 2006 Nov/Dec; (4): 556-560. Duncan GE, Anton SD, Newton RL Jr, Perri MG. Comparison of perceived health to physiological measures of health in Black and White women. Preventative Medicine. 2003 May; 36(5): 624-8 Durand JB. Heart failure management in African Americans: meeting the challenge. Journal of Clinical Hypertension. 2004 Apr; 6(4 Suppl1): 42-7. Goldberg RJ, Farmer C, Spencer FA, Pezzella S, Meyer T. Use of non-pharmacologic treatment approaches in patients with heart failure. International Journal of Cardiology. 2006 Feb; 348-353. Goodwin IC. 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