Differences in Incidence, Pharmacogenetics, Treatment and Socioeconomic factors in Heart Failure Outcomes between Sub-Saharan Blacks and White Patients
Main Article Content
Abstract
This review addresses the disparity in the phenotype of heart failure with respect to incidence, genetics, response to therapy as well as the socio-economic factors affecting heart failure indices between sub-Saharan blacks and white patients and attempts to propose solutions.
Keywords:
Heart failure, outcomes, racial differences, therapy
Article Details
How to Cite
SOFOWORA, Gbemiga G.; AJAYI, Adesuyi A..
Differences in Incidence, Pharmacogenetics, Treatment and Socioeconomic factors in Heart Failure Outcomes between Sub-Saharan Blacks and White Patients.
Medical Research Archives, [S.l.], v. 12, n. 7, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5587>. Date accessed: 05 aug. 2024.
doi: https://doi.org/10.18103/mra.v12i7.5587.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. May 2013;6(3):606-19. Doi:10.1161/HHF.0b013e318291329a
2. Dokainish H, Teo K, Zhu J, et al. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. Jul 2017;5(7):e665-e672. Doi:10.1016/S2214-109X(17)30196-1
3. Damasceno A, Mayosi BM, Sani M, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med. Oct 8 2012;172(18):1386-94. Doi:10.1001/archinternmed.2012.3310
4. Dzudie A, Barche B, Nkoke C, et al. Survival rate and predictors of 36-month mortality in patients with heart failure in Sub Saharan Africa: insights from the Douala Heart Failure Registry (Do-HF). Cardiovasc Diagn Ther. Oct 2022;12(5):577-588. Doi:10.21037/cdt-22-166
5. Dokainish H, Teo K, Zhu J, et al. Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol. Feb 1 2016;204:133-41. Doi:10.1016/j.ijcard.2015.11.183
6. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. Feb 20 2024;149(8):e347-e913. Doi:10.1161/CIR.0000000000001209
7. Shay CM, Gooding HS, Murillo R, Foraker R. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health. Prog Cardiovasc Dis. Jul-Aug 2015;58(1):41-9. Doi:10.1016/j.pcad.2015.05.003
8. Isezuo S, Sani MU, Talle A, et al. Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome. J Am Heart Assoc. Jan 4 2022;11(1):e020244. Doi:10.1161/JAHA.120.020244
9. Sliwa K, Wilkinson D, Hansen C, et al. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet. Mar 15 2008;371(9616):915-22. Doi:10.1016/S0140-6736(08)60417-1
10. Taylor MR, Sun AY, Davis G, Fiuzat M, Liggett SB, Bristow MR. Race, common genetic variation, and therapeutic response disparities in heart failure. JACC Heart Fail. Dec 2014;2(6):561-72. Doi:10.1016/j.jchf.2014.06.010
11. Sofowora GG, Dishy V, Muszkat M, et al. A common beta1-adrenergic receptor polymorphism (Arg389Gly) affects blood pressure response to beta-blockade. Clin Pharmacol Ther. Apr 2003;73(4):366-71. Doi:10.1016/s0009-9236(02)17734-4
12. Kurnik D, Li C, Sofowora GG, et al. Beta-1-adrenoceptor genetic variants and ethnicity independently affect response to beta-blockade. Pharmacogenet Genomics. Oct 2008;18(10):895-902. Doi:10.1097/FPC.0b013e328309733f
13. Liggett SB, Mialet-Perez J, Thaneemit-Chen S, et al. A polymorphism within a conserved beta(1)-adrenergic receptor motif alters cardiac function and beta-blocker response in human heart failure. Proc Natl Acad Sci U S A. Jul 25 2006;103(30):11288-93. Doi:10.1073/pnas.0509937103
14. Xie HG, Dishy V, Sofowora G, et al. Arg389Gly beta 1-adrenoceptor polymorphism varies in frequency among different ethnic groups but does not alter response in vivo. Pharmacogenetics. Apr 2001;11(3):191-7. Doi:10.1097/00008571-200104000-00002
15. Kurnik D, Friedman EA, Muszkat M, et al. Genetic variants in the alpha2C-adrenoceptor and G-protein contribute to ethnic differences in cardiovascular stress responses. Pharmacogenet Genomics. Sep 2008;18(9):743-50. Doi:10.1097/FPC.0b013e3282fee5a1
16. Dorr M, Schmidt CO, Spielhagen T, et al. beta-blocker therapy and heart rate control during exercise testing in the general population: role of a common G-protein beta-3 subunit variant. Pharmacogenomics. Sep 2010;11(9):1209-21. Doi:10.2217/pgs.10.88
17. Johnson AE, Hanley-Yanez K, Yancy CW, Taylor AL, Feldman AM, McNamara DM. Adrenergic Polymorphisms and Survival in African Americans With Heart Failure: Results From A-HeFT. J Card Fail. Jul 2019;25(7):553-560. Doi:10.1016/j.cardfail.2019.04.007
18. Tanus-Santos JE, Desai M, Flockhart DA. Effects of ethnicity on the distribution of clinically relevant endothelial nitric oxide variants. Pharmacogenetics. Nov 2001;11(8):719-25. Doi:10.1097/00008571-200111000-00011
19. McNamara DM, Holubkov R, Postava L, et al. Effect of the Asp298 variant of endothelial nitric oxide synthase on survival for patients with congestive heart failure. Circulation. Apr 1 2003;107(12): 1598-602. Doi:10.1161/01.CIR.0000060540.93836.AA
20. McNamara DM, Tam SW, Sabolinski ML, et al. Endothelial nitric oxide synthase (NOS3) polymorphisms in African Americans with heart failure: results from the A-HeFT trial. J Card Fail. Apr 2009;15(3):191-8. Doi:10.1016/j.cardfail.2008.10.028
21. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. May 3 2022;79(17):1757-1780. Doi:10.1016/j.jacc.2021.12.011
22. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. May 3 2022;79(17):e263-e421. Doi:10.1016/j.jacc.2021.12.012
23. Group CTS. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. Jun 4 1987;316(23):1429-35. Doi:10.1056/NEJM198706043162301
24. Investigators S, Yusuf S, Pitt B, Davis CE, Hood WB, Jr., Cohn JN. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. Sep 3 1992;327(10):685-91. Doi:10.1056/NEJM199209033271003
25. Ostergren JB. Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme. J Hypertens Suppl. Mar 2006;24(1):S3-7. Doi:10.1097/01.hjh.0000220400.08128.fa
26. Kourek C, Briasoulis A, Papamichail A, et al. Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium. Int J Mol Sci. Mar 7 2024;25(6)Doi:10.3390/ijms25063113
27. Ajayi AA, Balogun MO. Sustained beneficial effects of enalapril in Africans with congestive heart failure. Int J Cardiol. Oct 1990;29(1):55-61. Doi:10.1016/0167-5273(90)90273-8
28. Ajayi AA, Osodi OO, Akintomide AO. The influence of captopril on intrahospital mortality and duration of hospitalization in Nigerians with congestive heart failure. Int J Cardiol. Sep 1992;36(3):341-3. Doi:10.1016/0167-5273(92)90304-l
29. Eichhorn EJ, Bristow MR. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Curr Control Trials Cardiovasc Med. 2001;2(1):20-23. Doi:10.1186/cvm-2-1-020
30. Hjalmarson A, Goldstein S, Fagerberg B, et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA. Mar 8 2000;283(10):1295-302. Doi:10.1001/jama.283.10.1295
31. Ajayi AA, Sofowora GG, Balogun MO. Concurrent alpha 1 adrenergic blockade and angiotensin converting enzyme inhibition in the treatment of congestive heart failure. Int J Cardiol. Dec 6 1996;57(2):173-6. Doi:10.1016/s0167-5273(96)02799-4
32. Ajayi AA, Sofowora GG, Adigun AQ, Asiyanbola B. Adjunctive sympathoplegic therapy to ACE inhibition in Blacks with congestive heart failure: a comparison of alpha-1 with beta-1 blockade on exercise tolerance and cardiac sympathovagal reflex activity. Ethn Dis. Winter 2003;13(1):71-9.
33. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. Sep 2 1999;341(10):709-17. Doi:10.1056/NEJM199909023411001
34. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. Jan 6 2011;364(1):11-21. Doi:10.1056/NEJMoa1009492
35. Vardeny O, Cavallari LH, Claggett B, et al. Race influences the safety and efficacy of spironolactone in severe heart failure. Circ Heart Fail. Sep 1 2013;6(5):970-6. Doi:10.1161/CIRCHEARTFAILURE.113.000530
36. Xie Y, Wei Y, Li D, Pu J, Ding H, Zhang X. Mechanisms of SGLT2 Inhibitors in Heart Failure and Their Clinical Value. J Cardiovasc Pharmacol. Jan 1 2023;81(1):4-14. Doi:10.1097/FJC.0000000000001380
37. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. Sep 19 2020;396(10254):819-829. Doi:10.1016/S0140-6736(20)31824-9
38. Vaduganathan M, Docherty KF, Claggett BL, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. Sep 3 2022;400(10354):757-767. Doi:10.1016/S0140-6736(22)01429-5
39. Butt JH, Docherty KF, Claggett BL, et al. Dapagliflozin in Black and White Patients With Heart Failure Across the Ejection Fraction Spectrum. JACC Heart Fail. Apr 2023;11(4):375-388. Doi:10.1016/j.jchf.2022.11.014
40. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. Jun 12 1986;314(24):1547-52. Doi:10.1056/NEJM198606123142404
41. Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. Nov 11 2004;351(20):2049-57. Doi:10.1056/NEJMoa042934
42. Vaduganathan M, Claggett BL, Jhund PS, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet. Jul 11 2020;396(10244):121-128. Doi:10.1016/S0140-6736(20)30748-0
43. Karaye KM, Dokainish H, ElSayed A, et al. Clinical Profiles and Outcomes of Heart Failure in Five African Countries: Results from INTER-CHF Study. Glob Heart. 2021;16(1):50. Doi:10.5334/gh.940
44. Rosengren A, Smyth A, Rangarajan S, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health. Jun 2019;7(6):e748-e760. Doi:10.1016/S2214-109X(19)30045-2
45. Ajayi A, Sofowora GG, Ladipo G. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. Journal of The Nationa;l Medical Association. 2020;112(2):141-157.
46. Ogah OS, Stewart S, Onwujekwe OE, et al. Economic burden of heart failure: investigating outpatient and inpatient costs in Abeokuta, Southwest Nigeria. PLoS One. 2014;9(11):e113032. Doi:10.1371/journal.pone.0113032
47. Osenenko KM, Kuti E, Deighton AM, Pimple P, Szabo SM. Burden of hospitalization for heart failure in the United States: a systematic literature review. J Manag Care Spec Pharm. Feb 2022;28(2):157-167. Doi:10.18553/jmcp.2022.28.2.157
48. Brown AF, Ma GX, Miranda J, et al. Structural Interventions to Reduce and Eliminate Health Disparities. Am J Public Health. Jan 2019;109(S1):S72-S78. Doi:10.2105/AJPH.2018.304844
2. Dokainish H, Teo K, Zhu J, et al. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. Jul 2017;5(7):e665-e672. Doi:10.1016/S2214-109X(17)30196-1
3. Damasceno A, Mayosi BM, Sani M, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med. Oct 8 2012;172(18):1386-94. Doi:10.1001/archinternmed.2012.3310
4. Dzudie A, Barche B, Nkoke C, et al. Survival rate and predictors of 36-month mortality in patients with heart failure in Sub Saharan Africa: insights from the Douala Heart Failure Registry (Do-HF). Cardiovasc Diagn Ther. Oct 2022;12(5):577-588. Doi:10.21037/cdt-22-166
5. Dokainish H, Teo K, Zhu J, et al. Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol. Feb 1 2016;204:133-41. Doi:10.1016/j.ijcard.2015.11.183
6. Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. Feb 20 2024;149(8):e347-e913. Doi:10.1161/CIR.0000000000001209
7. Shay CM, Gooding HS, Murillo R, Foraker R. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health. Prog Cardiovasc Dis. Jul-Aug 2015;58(1):41-9. Doi:10.1016/j.pcad.2015.05.003
8. Isezuo S, Sani MU, Talle A, et al. Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome. J Am Heart Assoc. Jan 4 2022;11(1):e020244. Doi:10.1161/JAHA.120.020244
9. Sliwa K, Wilkinson D, Hansen C, et al. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet. Mar 15 2008;371(9616):915-22. Doi:10.1016/S0140-6736(08)60417-1
10. Taylor MR, Sun AY, Davis G, Fiuzat M, Liggett SB, Bristow MR. Race, common genetic variation, and therapeutic response disparities in heart failure. JACC Heart Fail. Dec 2014;2(6):561-72. Doi:10.1016/j.jchf.2014.06.010
11. Sofowora GG, Dishy V, Muszkat M, et al. A common beta1-adrenergic receptor polymorphism (Arg389Gly) affects blood pressure response to beta-blockade. Clin Pharmacol Ther. Apr 2003;73(4):366-71. Doi:10.1016/s0009-9236(02)17734-4
12. Kurnik D, Li C, Sofowora GG, et al. Beta-1-adrenoceptor genetic variants and ethnicity independently affect response to beta-blockade. Pharmacogenet Genomics. Oct 2008;18(10):895-902. Doi:10.1097/FPC.0b013e328309733f
13. Liggett SB, Mialet-Perez J, Thaneemit-Chen S, et al. A polymorphism within a conserved beta(1)-adrenergic receptor motif alters cardiac function and beta-blocker response in human heart failure. Proc Natl Acad Sci U S A. Jul 25 2006;103(30):11288-93. Doi:10.1073/pnas.0509937103
14. Xie HG, Dishy V, Sofowora G, et al. Arg389Gly beta 1-adrenoceptor polymorphism varies in frequency among different ethnic groups but does not alter response in vivo. Pharmacogenetics. Apr 2001;11(3):191-7. Doi:10.1097/00008571-200104000-00002
15. Kurnik D, Friedman EA, Muszkat M, et al. Genetic variants in the alpha2C-adrenoceptor and G-protein contribute to ethnic differences in cardiovascular stress responses. Pharmacogenet Genomics. Sep 2008;18(9):743-50. Doi:10.1097/FPC.0b013e3282fee5a1
16. Dorr M, Schmidt CO, Spielhagen T, et al. beta-blocker therapy and heart rate control during exercise testing in the general population: role of a common G-protein beta-3 subunit variant. Pharmacogenomics. Sep 2010;11(9):1209-21. Doi:10.2217/pgs.10.88
17. Johnson AE, Hanley-Yanez K, Yancy CW, Taylor AL, Feldman AM, McNamara DM. Adrenergic Polymorphisms and Survival in African Americans With Heart Failure: Results From A-HeFT. J Card Fail. Jul 2019;25(7):553-560. Doi:10.1016/j.cardfail.2019.04.007
18. Tanus-Santos JE, Desai M, Flockhart DA. Effects of ethnicity on the distribution of clinically relevant endothelial nitric oxide variants. Pharmacogenetics. Nov 2001;11(8):719-25. Doi:10.1097/00008571-200111000-00011
19. McNamara DM, Holubkov R, Postava L, et al. Effect of the Asp298 variant of endothelial nitric oxide synthase on survival for patients with congestive heart failure. Circulation. Apr 1 2003;107(12): 1598-602. Doi:10.1161/01.CIR.0000060540.93836.AA
20. McNamara DM, Tam SW, Sabolinski ML, et al. Endothelial nitric oxide synthase (NOS3) polymorphisms in African Americans with heart failure: results from the A-HeFT trial. J Card Fail. Apr 2009;15(3):191-8. Doi:10.1016/j.cardfail.2008.10.028
21. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. May 3 2022;79(17):1757-1780. Doi:10.1016/j.jacc.2021.12.011
22. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. May 3 2022;79(17):e263-e421. Doi:10.1016/j.jacc.2021.12.012
23. Group CTS. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. Jun 4 1987;316(23):1429-35. Doi:10.1056/NEJM198706043162301
24. Investigators S, Yusuf S, Pitt B, Davis CE, Hood WB, Jr., Cohn JN. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med. Sep 3 1992;327(10):685-91. Doi:10.1056/NEJM199209033271003
25. Ostergren JB. Angiotensin receptor blockade with candesartan in heart failure: findings from the Candesartan in Heart failure--assessment of reduction in mortality and morbidity (CHARM) programme. J Hypertens Suppl. Mar 2006;24(1):S3-7. Doi:10.1097/01.hjh.0000220400.08128.fa
26. Kourek C, Briasoulis A, Papamichail A, et al. Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium. Int J Mol Sci. Mar 7 2024;25(6)Doi:10.3390/ijms25063113
27. Ajayi AA, Balogun MO. Sustained beneficial effects of enalapril in Africans with congestive heart failure. Int J Cardiol. Oct 1990;29(1):55-61. Doi:10.1016/0167-5273(90)90273-8
28. Ajayi AA, Osodi OO, Akintomide AO. The influence of captopril on intrahospital mortality and duration of hospitalization in Nigerians with congestive heart failure. Int J Cardiol. Sep 1992;36(3):341-3. Doi:10.1016/0167-5273(92)90304-l
29. Eichhorn EJ, Bristow MR. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Curr Control Trials Cardiovasc Med. 2001;2(1):20-23. Doi:10.1186/cvm-2-1-020
30. Hjalmarson A, Goldstein S, Fagerberg B, et al. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA. Mar 8 2000;283(10):1295-302. Doi:10.1001/jama.283.10.1295
31. Ajayi AA, Sofowora GG, Balogun MO. Concurrent alpha 1 adrenergic blockade and angiotensin converting enzyme inhibition in the treatment of congestive heart failure. Int J Cardiol. Dec 6 1996;57(2):173-6. Doi:10.1016/s0167-5273(96)02799-4
32. Ajayi AA, Sofowora GG, Adigun AQ, Asiyanbola B. Adjunctive sympathoplegic therapy to ACE inhibition in Blacks with congestive heart failure: a comparison of alpha-1 with beta-1 blockade on exercise tolerance and cardiac sympathovagal reflex activity. Ethn Dis. Winter 2003;13(1):71-9.
33. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. Sep 2 1999;341(10):709-17. Doi:10.1056/NEJM199909023411001
34. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. Jan 6 2011;364(1):11-21. Doi:10.1056/NEJMoa1009492
35. Vardeny O, Cavallari LH, Claggett B, et al. Race influences the safety and efficacy of spironolactone in severe heart failure. Circ Heart Fail. Sep 1 2013;6(5):970-6. Doi:10.1161/CIRCHEARTFAILURE.113.000530
36. Xie Y, Wei Y, Li D, Pu J, Ding H, Zhang X. Mechanisms of SGLT2 Inhibitors in Heart Failure and Their Clinical Value. J Cardiovasc Pharmacol. Jan 1 2023;81(1):4-14. Doi:10.1097/FJC.0000000000001380
37. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. Sep 19 2020;396(10254):819-829. Doi:10.1016/S0140-6736(20)31824-9
38. Vaduganathan M, Docherty KF, Claggett BL, et al. SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet. Sep 3 2022;400(10354):757-767. Doi:10.1016/S0140-6736(22)01429-5
39. Butt JH, Docherty KF, Claggett BL, et al. Dapagliflozin in Black and White Patients With Heart Failure Across the Ejection Fraction Spectrum. JACC Heart Fail. Apr 2023;11(4):375-388. Doi:10.1016/j.jchf.2022.11.014
40. Cohn JN, Archibald DG, Ziesche S, et al. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med. Jun 12 1986;314(24):1547-52. Doi:10.1056/NEJM198606123142404
41. Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. Nov 11 2004;351(20):2049-57. Doi:10.1056/NEJMoa042934
42. Vaduganathan M, Claggett BL, Jhund PS, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet. Jul 11 2020;396(10244):121-128. Doi:10.1016/S0140-6736(20)30748-0
43. Karaye KM, Dokainish H, ElSayed A, et al. Clinical Profiles and Outcomes of Heart Failure in Five African Countries: Results from INTER-CHF Study. Glob Heart. 2021;16(1):50. Doi:10.5334/gh.940
44. Rosengren A, Smyth A, Rangarajan S, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Lancet Glob Health. Jun 2019;7(6):e748-e760. Doi:10.1016/S2214-109X(19)30045-2
45. Ajayi A, Sofowora GG, Ladipo G. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. Journal of The Nationa;l Medical Association. 2020;112(2):141-157.
46. Ogah OS, Stewart S, Onwujekwe OE, et al. Economic burden of heart failure: investigating outpatient and inpatient costs in Abeokuta, Southwest Nigeria. PLoS One. 2014;9(11):e113032. Doi:10.1371/journal.pone.0113032
47. Osenenko KM, Kuti E, Deighton AM, Pimple P, Szabo SM. Burden of hospitalization for heart failure in the United States: a systematic literature review. J Manag Care Spec Pharm. Feb 2022;28(2):157-167. Doi:10.18553/jmcp.2022.28.2.157
48. Brown AF, Ma GX, Miranda J, et al. Structural Interventions to Reduce and Eliminate Health Disparities. Am J Public Health. Jan 2019;109(S1):S72-S78. Doi:10.2105/AJPH.2018.304844