Title: Is Heart Failure in African Americans a Distinct Entity?
Headings: Is Heart Failure in African Americans a Distinct Entity?
Congestive Heart Failure
Is Heart Failure in African Americans a Distinct Entity?
Abstract and Introduction

Content: Despite the advances in treatment of heart failure with neurohormonal attenuation, there appears to be inconsistency in the response of African Americans compared to Caucasians. This discordance with regard to response to treatment and etiology of heart failure between African Americans and Caucasians begets the question whether heart failure in African Americans is indeed a distinct clinical entity. Mortality from heart failure is 2.5-times greater among African Americans compared to Caucasians <65 years of age. [ 1] African Americans develop heart failure at an earlier age and the hospitalization rates are substantially higher than those among Caucasians. [ 2, 3] The reason for the worse morbidity and mortality in African American heart failure patients is unclear, thus begetting the question of whether heart failure in African Americans is truly a distinct clinical entity. In order to answer this question one must consider not only the etiology of heart failure but also the relative response to conventional heart failure therapy and participation in heart failure trials from which the evidence-based data are collated. Although there are multiple etiologies for heart failure, the predominant factor in the United States is coronary artery disease. However, in African Americans the relative prevalence of hypertension as an attributable etiology of heart failure is substantially higher than among Caucasians ( Table 1 ). Also the severity of hypertension as well as associated end-organ damage such as end-stage renal disease, left ventricular hypertrophy, and coronary artery disease is comparatively worse in African Americans than in the general population. [ 3] Many investigators have demonstrated racial differences in the relative efficacy of various antihypertensive agents. [