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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

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Heart failure is almost always a chronic, longterm condition, although it can sometimes develop suddenly

Introduction 

This condition may affect the right side, the left side, or both sides of the heart

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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 

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shortness of air (with activity, or after lying down for a while

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cough

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difficulty sleeping

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fatigue

weight gain

Who this Affects? 

According to the National Institutes of Health, about 5 million Americans have heart failure

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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

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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 

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Angiotensin-converting enzyme (ACE) inhibitors Beta blockers (BB)

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Diuretics (Water Pills)

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BiDil (isosorbide/hydralazine)

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Vasodilators

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Digitalis Preparations

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Angiotensin II Receptor Blockers

Lifestyle Modification 

Diet

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Physical activity

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Weight management

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Tobacco Use

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Alcohol use

Diet 

Obesity is increasingly recognized as a public health epidemic and modifiable risk factor for coronary heart disease (CHD)

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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

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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

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Increased HDL

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Decreased serum triglycerides

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Increased caloric expenditure

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Decreased weight

Physical Activity 

Regular physical activity is associated with the prevention and control of virtually every known modifiable risk factor for CHF

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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)

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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

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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.

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Lifestyle modification, especially physical activity can reduce the risk associated with CHF

References  

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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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