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					 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. Rural African American women’s perception of exercise. Alabama Nurse. 2007 Jun-Aug; 34(2): 18-9.
   Katz DL. Lifestyle and dietary modification for prevention of heart failure. Medial Clinics of North America. 2004 Sep; 88(5):
    1295-320.
   Oexmann MJ, Thomas JC, Taylor KB, O’Neil PM, Gravey WT, Lackland DT, Egan BM. Short-term impact of a church based
    approach to lifestyle change on cardiovascular risk in African Americans. Ethnicity and Disease. 2000 Winter; 10(1): 17-23.
   Svetkey LP, Erlinger TP, Vollmer WM, Feldstein A, Cooper LS, Appel LJ, Elmer PJ, Harsha D, Stevens VJ. Effects of lifestyle
    modifications on blood pressure by race, sex, hypertension, and age. Journal of Human Hypertension. 2005 Jan; 19(1): 21-31.
   Wessel TR, Arant CB, Olson MB, Johnson BD, Reis SE, Sharaf BL, Shaw LJ, Handberg E, Sopko G, Kelsey SF, Pepine CJ, Merz
    NB. Relationship of physical fitness vs. body mass index with coronary artery disease and cardiovascular events in women.
    Journal of the American Medical Association. 2004 Sep 8; 292(10): 1179-87.
   Wilson, DK, Kirtland KA, Ainsworth BE, Addy CL. Socioeconomic status and perception of access and safety for physical
    activity. Annals of Behavioral Medicine. 204 Nov; 28 (1): 20-28
   Yancy CW. Heart failure in African Americans. The American Journal of Cardiology. 2005 Oct; 96 (7B): 3i-12i.
   Yancy CW. Heart failure in blacks: etiologic and epidemiologic differences. Current Cardiology Reports. 2001 May; 3(3): 191-7.
   Yancy CW. The prevention of heart failure in minority communities and discrepancies in health care delivery systems. Medical
    Clinics of North America. 2004 Sep; 88(5): 1347-68.
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posted:2/17/2013
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