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, 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

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

cough

difficulty sleeping

fatigue
weight gain
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
enzyme (ACE) inhibitors
Beta blockers (BB)

Diuretics (Water Pills)

BiDil
(isosorbide/hydralazine)

Vasodilators

Digitalis Preparations

Angiotensin II Receptor
Blockers
Lifestyle Modification

Diet

Physical activity

Weight management

Tobacco Use

Alcohol use
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 HDL

Decreased serum
triglycerides

Increased caloric
expenditure

Decreased weight
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
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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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