When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African-American and Hispanic Women.

African-American and Hispanic postmenopausal women have the highest risk for heart failure (HF) compared to other races, but HF prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident HF hospitalization (HFH) among high-risk postmenopausal minority women.
Using the Women’s Health Initiative Study, African-American and U.S. Hispanic women were classified as high-risk for incident HFH with ≥1 traditional HF risk factors and highest tertile HF genetic risk scores. Positive (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted sub-distribution hazard ratios (SHR) of developing HFH were determined with death as a competing risk. Positive deviance indicated not developing incident HFH with ≥1 risk factors and highest tertile for genetic risk. Among 7986 African-American women (16 years mean follow-up), 27.0% demonstrated positive deviance. Among high-risk African-American women, optimism was associated with modestly reduced risk of HFH [SHR 0.94(95%CI:0.91,0.99)], and social strain was associated with modestly increased risk of HFH [SHR 1.07(95%CI:1.02,1.12)] in initial models; however, no psychosocial factors were associated with HFH in fully-adjusted analyses. Among 3,341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of HFH [SHR 1.97(95%CI:1.06,3.63)] in unadjusted analyses; however, no psychosocial factors were associated with HFH in fully-adjusted analyses.
Among post-menopausal African-American and Hispanic women, a significant proportion remained free from HFH despite having highest genetic risk profile and ≥1 traditional risk factors. No observed psychosocial factors were associated with incident HFH in high-risk African-Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African-American and Hispanic women.

Copyright © 2020. Published by Elsevier Inc.