Burden of dyspnea and fatigue in heart failure varies by race and is heritable
Oliver-McNeil SM, Schutte D, Peterson E, Leszczynski K, Williams LK, Gui H, Lanfear DE. Burden of dyspnea and fatigue in heart failure varies by race and is heritable. J Am Coll Cardiol. 2018;71(11)
J Am Coll Cardiol
Background: The drivers of symptom burden in heartfailure (HF) are poorly understood. Small studies have suggested racial disparities, but data are sparse, and the extent to which these disparities may have genetic underpinnings is unclear. Methods: A prospective genetic registry enrolled 1765 patients with HF. All subjects underwent genome wide genotyping and completed the Kansas City Cardiomypathy Questionnaire (KCCQ). Dyspneaand fatigue severity (KCCQ questions 5-8) were compared by self identifed race (African American [AA] vs. white) using Wilcoxon 2 sample test. Heritability of symptom burden was calculated using the Linkage Disequilibrium Adjusted Kinship method, stratifed by race, and then adjusted for potential confounders. Results: A total of 1662 patient had complete data for analysis; the average age was 69 years, 65% had EF<50%, 42% were female, and 858 were AA (52%). Overall, AA patients had worse dyspnea (Q8, mean 4.29 vs 4.44, p=0.021), and this was particularly true in HFrEF (Q7 and Q8, p=0.048 and 0.011, respectively). Both fatigue and dyspnea exhibited substantial heriability (Table), with highest estimates for fatigue (some as high as 50%). In fully adjusted models, fatigue Q6 had estimated heriability of 34% and 48% in white and AA patients respectively. Conclusion: Racial disparities in symptom burden exist inpersons with HF, with AA having more dyspnea. Symptom burden is a signifcantly heritable trait, with genetic background accounting for up to 50% ofvariability.