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Serial Cardiac Troponin Measurements: A Prediction Tool for Heart Failure Risk in Black Patients?

      Black adults are disproportionately affected by heart failure (HF), and incident HF rates are increasing in Black adults, who also have higher risks of hospitalization and age-adjusted mortality due to HF than White adults.
      • Young BA
      Health disparities in advanced heart failure treatment: the intersection of race and sex.
      • Chang PP
      • Wruck LM
      • Shahar E
      • Rossi JS
      • Loehr LR
      • Russell SD
      • et al.
      Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005-2014): ARIC Study Community Surveillance.
      • Ziaeian B
      • Kominski GF
      • Ong MK
      • Mays VM
      • Brook RH
      • Fonarow GC
      National differences in trends for heart failure hospitalizations by sex and race/ethnicity.
      These disparities in HF have, in part, been attributed to a higher prevalence of cardiovascular (CV) risk factors, inadequate treatment of HF and underuse of HF guideline-directed medical therapy.
      • Ilonze O
      • Free K
      • Breathett K.
      Unequitable heart failure therapy for Black, Hispanic and American-Indian patients.
      ,
      • Breathett K
      • Liu WG
      • Allen LA
      • Daugherty SL
      • Blair IV
      • Jones J
      • et al.
      African Americans are less likely to receive care by a cardiologist during an intensive care unit admission for heart failure.
      Understanding novel factors that may contribute to the heterogeneity of HF in Black individuals remains an unmet need.
      • Nayak A
      • Hicks AJ
      • Morris AA.
      Understanding the complexity of heart failure risk and treatment in Black patients.
      Tools that can be used for early detection of incident HF are potentially impactful because early detection can open the window for preventive or therapeutic strategies that reduce the risk of future clinical HF. Biomarkers, such as natriuretic peptides and high-sensitivity troponins, may represent emerging tools to better predict risk of incident HF in vulnerable populations at risk of cardiovascular disease (CVD) due to the reduced detection threshold of current assays. High-sensitivity cardiac troponins (hs-cTns) are specific and sensitive biomarkers of myocardial injury, whereas elevated natriuretic peptide levels in response to increased wall stretch due to volume or pressure overload are associated with increased risk of incident HF in adults.
      • Heidenreich P
      • Bozkurt B
      • Aguilar D
      • Allen LA
      • Byun JJ
      • Colvin MM,
      • 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.
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      References

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        Health disparities in advanced heart failure treatment: the intersection of race and sex.
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      Linked Article

      • Longitudinal Changes in Cardiac Troponin and Risk of Heart Failure Among Black Adults
        Journal of Cardiac Failure
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          Heart failure (HF) affects 6.2 million adults in the United States, and prevalence is expected to increase.1 Black adults are more likely to develop HF compared with other racial groups.2 Incident HF rates have increased more in Black vs White adults, mostly owing to the increase in HF with preserved ejection fraction (HFpEF), which is associated with high morbidity and mortality and has few effective therapies.3,4 Racial disparities in HF risk are related in part to differences in social determinants of health and traditional risk factor burden such as hypertension (HTN) and diabetes mellitus (DM), but novel factors may also contribute to heterogeneity in HF risk.
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