Diabetes Mellitus, Race, and Effects of Omega-3 Fatty Acids on Incidence of Heart Failure Hospitalization.

OBJECTIVES: The primary aim was to evaluate whether prevalent type 2 diabetes (T2D) modifies the effects of omega-3 supplementation on heart failure (HF) hospitalization. The secondary aim was to examine if race modifies the effects of omega-3 supplements on HF risk. BACKGROUND: It is unclear whether race and T2D modify the effects of omega-3 supplementation on the incidence of HF. METHODS: In this ancillary study of the parent VITAL (Vitamin D and Omega-3 Trial)-a completed randomized trial testing the efficacy of vitamin D and omega-3 fatty acids on cardiovascular diseases and cancer, we assessed the role of T2D and race on the effects of omega-3 supplements on the incidence of HF hospitalization (adjudicated by a review of medical records and supplemented with a query of Centers for Medicare and Medicaid Services data). RESULTS: When omega-3 supplements were compared with placebo, the HR for first HF hospitalization was 0.69 (95% CI: 0.50-0.95) in participants with prevalent T2D and 1.09 (95% CI: 0.88-1.34) in those without T2D (P for interaction = 0.019). Furthermore, prevalent T2D modified the effects of omega-3 fatty acids on the incidence of recurrent HF hospitalization (HR: 0.53; 95% CI: 0.41-0.69 in participants with prevalent T2D vs HR: 1.07; 95% CI: 0.89-1.28 in those without T2D; P interaction <0.0001). In our secondary analysis, omega-3 supplementation reduced recurrent HF hospitalization only in Black participants (P interaction race × omega-3 = 0.0497). CONCLUSIONS: Our data show beneficial effects of omega-3 fatty acid supplements on incidence of HF hospitalization in participants with T2D but not in those without T2D, and such benefit appeared to be stronger in Black participants with T2D. (Intervention With Vitamin D and Omega-3 Supplements and Incident Heart Failure; NCT02271230; Vitamin D and Omega-3 Trial [VITAL]; NCT01169259 [parent study]).

Contemporary Reevaluation of Race and Ethnicity With Outcomes in Heart Failure.

Background Variation in outcomes by race/ethnicity in adults with heart failure (HF) has been previously observed. Identifying factors contributing to these variations could help target interventions. We evaluated the association of race/ethnicity with HF outcomes and potentially contributing factors within a contemporary HF cohort. Methods and Results We identified members of Kaiser Permanente Northern California, a large integrated healthcare delivery system, who were diagnosed with HF between 2012 and 2016 and had at least 1 year of prior continuous membership and left ventricular ejection fraction data. We used Cox regression with time-dependent covariates to evaluate the association of self-identified race/ethnicity with HF or all-cause hospitalization and all-cause death, with backward selection for potential explanatory variables. Among 34 621 patients with HF, compared with White patients, Black patients had a higher rate of HF hospitalization (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18-1.38) but a lower rate of death (adjusted HR, 0.78; 95% CI, 0.72-0.85). In contrast, Asian/Pacific Islander patients had similar rates of HF hospitalization, but lower rates of all-cause hospitalization (adjusted HR, 0.89; 95% CI, 0.85-0.93) and death (adjusted HR, 0.75; 95% CI, 0.69-0.80). Hispanic patients also had a lower rate of death (adjusted HR, 0.85; 95% CI, 0.80-0.91). Sensitivity analyses showed that effect sizes for Black patients were larger among patients with reduced ejection fraction. Conclusions In a contemporary and diverse population with HF, Black patients experienced a higher rate of HF hospitalization and a lower rate of death compared with White patients. In contrast, selected outcomes for Asian/Pacific Islander and Hispanic patients were more favorable compared with White patients. The observed differences were not explained by measured potentially modifiable factors, including pharmacological treatment. Future research is needed to identify explanatory mechanisms underlying ongoing racial/ethnic variation to target potential interventions.

Predictive Accuracy of Heart Failure-Specific Risk Equations in an Electronic Health Record-Based Cohort.

BACKGROUND: Guidelines recommend identification of individuals at risk for heart failure (HF). However, implementation of risk-based prevention strategies requires validation of HF-specific risk scores in diverse, real-world cohorts. Therefore, our objective was to assess the predictive accuracy of the Pooled Cohort Equations to Prevent HF within a primary prevention cohort derived from the electronic health record. METHODS: We retrospectively identified patients between the ages of 30 to 79 years in a multi-center integrated healthcare system, free of cardiovascular disease, with available data on HF risk factors, and at least 5 years of follow-up. We applied the Pooled Cohort Equations to Prevent HF tool to calculate sex and race-specific 5-year HF risk estimates. Incident HF was defined by the International Classification of Diseases codes. We assessed model discrimination and calibration, comparing predicted and observed rates for incident HF. RESULTS: Among 31 256 eligible adults, mean age was 51.4 years, 57% were women and 11% Black. Incident HF occurred in 568 patients (1.8%) over 5-year follow-up. The modified Pooled Cohort Equations to Prevent HF model for 5-year risk prediction of HF had excellent discrimination in White men (C-statistic 0.82 [95% CI, 0.79-0.86]) and women (0.82 [0.78-0.87]) and adequate discrimination in Black men (0.69 [0.60-0.78]) and women (0.69 [0.52-0.76]). Calibration was fair in all race-sex subgroups (χ2<20). CONCLUSIONS: A novel sex- and race-specific risk score predicts incident HF in a real-world, electronic health record-based cohort. Integration of HF risk into the electronic health record may allow for risk-based discussion, enhanced surveillance, and targeted preventive interventions to reduce the public health burden of HF.

Relation of Magnesium Intake With Cardiac Function and Heart Failure Hospitalizations in Black Adults: The Jackson Heart Study.

BACKGROUND: Little is known about magnesium intake and risk of heart failure (HF) hospitalizations, particularly in blacks. We hypothesize that magnesium intake relates to HF hospitalization in blacks. METHODS AND RESULTS: From the Jackson Heart Study cohort (n=5301), we studied 4916 blacks recruited during 2000 to 2004 in Jackson (Mississippi), who completed an 158-item Food-Frequency Questionnaire that included dietary supplements. Daily magnesium intake derived from the questionnaire was divided by the body weight to account for body storage and stratified by quartiles (0.522-2.308, 2.309-3.147, 3.148-4.226, and ≥4.227 mg magnesium intake/kg). Cox proportional hazards modeling assessed the association between quartiles of magnesium intake/kg and hospitalizations for HF adjusting for HF risk, energy intake, and dietary factors. The cohort had a mean age=55.3 (SD=12.7 years) and composed of 63.4% women, 21.6% diabetes mellitus, 62.7% hypertension, 7.1% coronary disease, and 2.8% with known HF. When compared with participants in the first quartile of magnesium intake/kg, those with higher magnesium intake (>2.308 mg/kg) had decreased risk of HF admission, with adjusted hazard ratios of 0. 66(95% confidence interval, 0.47-0.94) in the second quartile to 0.47 (95% confidence interval, 0.27-0.82) in the highest quartile. Results were similar when individuals with previously diagnosed HF (2.8%) were excluded or when the analysis was repeated using quartiles of magnesium intake without accounting for body weight. CONCLUSIONS: Magnesium intake <2.3 mg/kg was related to increased risk of subsequent HF hospitalizations. Future studies are needed to test whether serum magnesium levels predict risk of HF.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure.

INTRODUCTION: There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. METHODS: This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. RESULTS: Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients. CONCLUSIONS: By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

How do depressive symptoms influence self-care among an ethnic minority population with heart failure?

OBJECTIVES: Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF. DESIGN: In this mixed methods study, 30 Black patients (mean age 59.63 SD +/- 15 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase. RESULTS: Self-care was very poor in the sample. Forty percent of the sample had evidence of depressive symptoms (PHQ-9 > or = 10; mean 7.59 +/- 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P = .029). In the qualitative data, individuals described depressive mood as "feeling blue... like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers. CONCLUSIONS: Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.

Sociocultural influences on heart failure self-care among an ethnic minority black population.

BACKGROUND: Heart failure (HF) places a disproportionate burden on ethnic minority populations, including blacks, who have the highest risk of developing HF and experience poorer outcomes. Self-care, which encompasses adherence to diet, medication, and symptom management, can significantly improve outcomes. However, HF self-care is notoriously poor in ethnic minority black populations. OBJECTIVES: Because culture is central to the development of self-care, we sought to describe the self-care practices and sociocultural influences of self-care in an ethnic minority black population with HF. METHODS: In this mixed-methods study, 30 black patients with HF (mean [SD] age, 59.63 [15] years; 67% New York Heart Association class III) participated in interviews about self-care, cultural beliefs, and social support and completed standardized instruments measuring self-care and social support. Thematic content analysis revealed themes about sociocultural influences of self-care. Qualitative and quantitative data were integrated in the final analytic phase. RESULTS: Self-care was very poor (standardized mean [SD] Self-care of Heart Failure Index [SCHFI] maintenance, 60.05 [18.12]; SCHFI management, 51.19 [18.98]; SCHFI confidence, 62.64 [8.16]). The overarching qualitative theme was that self-care is influenced by cultural beliefs, including the meaning ascribed to HF, and by social norms. The common belief that HF was inevitable ("all my people have bad hearts") or attributed to "stress" influenced daily self-care. Spirituality was also linked to self-care ("the doctor may order it but I pray on it"). Cultural beliefs supported some self-care behaviors like medication adherence. Difficulty reconciling cultural preferences (favorite foods) with the salt-restricted diet was evident. The significant relationship of social support and self-care (r = 0.451, P = .01) was explicated by the qualitative data. Social norms interfered with willingness to access social support, and "selectivity" in whom individuals confided led to social isolation and confounded self-care practices. CONCLUSIONS: Research to develop and test culturally sensitive interventions is needed. Community-based interventions that provide culturally acceptable resources to facilitate self-care should be explored.

Yoga for heart failure patients: a feasibility pilot study with a multiethnic population.

BACKGROUND: Congestive heart failure (CHF) is highly prevalent and the most costly cardiovascular illness in the United States. Yoga is known to be effective in lowering stress, lessening depression, and increasing physical fitness and may be used as an adjuvant management program for CHF patients. PRIMARY STUDY OBJECTIVE: To determine the feasibility of a yoga intervention program among a multiethnic CHF population living in underserved neighborhoods. METHODS: Uncontrolled intervention trial. SETTING: Kaiser Permanente Medical Centers, Richmond and Oakland, California. PARTICIPANTS: 14 CHF patients (7 female), mean age 64 (SD=6.4) years, and 62% African-American. INTERVENTION: Eight-week, 2x/week, 1-hr yoga classes that included meditation, breathing exercises, gentle yoga poses, and relaxation. PRIMARY OUTCOME MEASURES: The intervention feasibility was measured by recruitment rates, participant retention and adherence. Body weight and self-reported depression and quality of life were measured before and after the intervention. RESULTS: Among the 14 patients enrolled, 13 completed the intervention. Of those who completed the trial, 92% attended at least 50% of the classes. There was a significant reduction in weight (-3.5 lb, p=0.01) and improvement in the severity of depression (p<0.05), as well as a trend toward increased quality of life (p=08). No adverse events were observed. CONCLUSIONS: This pilot trial demonstrates that it is feasible for patients with CHF to incorporate yoga into their lifestyle. Yoga may help with routine disease management, prevention of fluid retention, and improvement of depression and quality of life. A larger trial is needed to confirm efficacy and to determine the long-term effects on other important outcomes, such as hospital re-admission rates or prognostic biomarkers.

Benefits of yoga for African American heart failure patients.

BACKGROUND: The number of African American (AA) patients living with heart failure (HF) has been increasing, especially among the economically disadvantaged. Yoga therapy has been found to improve physical and psychological parameters among healthy individuals, but its effect in patients with HF remains unknown. The purpose of this study was to examine the effects of yoga therapy on cardiovascular endurance (VO2peak), flexibility, quality of life (QoL), and inflammatory markers on medically stable HF patients. METHODS: Forty patients (38 AA, 1 Asian, and 1 Caucasian) with systolic or diastolic HF were randomized to the yoga group (YG, n = 21) or the control group (CG, n = 19). All patients were asked to follow a home walk program. Premeasurement and postmeasurement included a treadmill stress test to peak exertion, flexibility, interleukin-6 (IL-6), C-reactive protein (CRP), and extracellular superoxide dismutase (EC-SOD). QoL was assessed by the Minnesota Living with Heart Failure Questionnaire (MLwHFQ). RESULTS: The statistical analyses (assessed by ANOVA and t-tests) were significant for favorable changes in the YG, compared with those in the CG, for flexibility (P = 0.012), treadmill time (P = 0.002), VO2peak (P = 0.003), and the biomarkers (IL-6, P = 0.004; CRP, P = 0.016; and EC-SOD, P = 0.012). Within the YG, pretest to posttest scores for the total (P = 0.02) and physical subscales (P < 0.001) of the MLwHFQ were improved. CONCLUSIONS: Yoga therapy offered additional benefits to the standard medical care of predominantly AA HF patients by improving cardiovascular endurance, QoL, inflammatory markers, and flexibility.

Psychosocial factors, quality of life, and psychological distress: ethnic differences in patients with heart failure.

Advances in treatment have prolonged life in heart failure (HF) patients, leading to increased attention to quality of life (QOL) and psychological functioning. It is not clear if ethnic differences exist in factors associated with psychological well-being. We examined psychosocial factors associated with depression and anxiety in 97 HF patients. Medical records were reviewed and patients (M age 53, 50% African American) completed surveys examining social support, coping, spirituality, and QOL for their association with depression and anxiety. Multiple regressions suggested that psychosocial factors were associated with psychological health. Patients with lower social support, lower meaning/peace and more negative coping reported greater depression; positive coping, and lower meaning/peace were associated with higher anxiety. Ethnicity stratified models suggested that spiritual well-being was associated with depression only among African Americans and QOL partially mediated this relationship. Findings suggest the importance of considering the unique psychosocial needs of diverse populations to appropriately target clinical interventions.

Pacific Islanders' perspectives on heart failure management.

OBJECTIVE: To identify the health beliefs, attitudes, practices, and social and family relations important in heart failure treatment among Pacific Islanders. METHODS: Four focus groups were convened with 36 Native Hawaiians and Samoans with heart failure and their family caregivers. Thematic data analysis was used to categorize data into four domains: health beliefs and attitudes, preferred health practices, social support systems, and barriers to heart failure care. RESULTS: Common coping styles and emotional experiences of heart failure in this population included avoidance or denial of illness, hopelessness and despair, and reliance on spiritual/religious beliefs as a means of support. Among study participants, more Samoans preferred to be treated by physicians whereas more Native Hawaiians preferred traditional Hawaiian methods of healing. Two types of social support (informational and tangible-instrumental) were identified as important in heart failure care. Barriers to heart failure care included poor knowledge of heart failure, lack of trust in physicians' care, poor physician-patient relations, finances, dietary changes, and competing demands on time. CONCLUSION: The recruitment, retention, and adherence of Pacific Islanders to heart failure interventions is affected by an array of psychosocial and socio-cultural factors. PRACTICE IMPLICATIONS: Interventions might be improved by offering participants accurate and detailed information about heart failure and its treatment, engaging the extended family in providing necessary supports, and providing tools to facilitate physician-patient relationships, among others, within the context of a larger socio-cultural system.

Psychometric evaluation of the Chinese version of the Minnesota Living with Heart Failure Questionnaire.

BACKGROUND: Health-related quality of life has emerged as an important outcome in treating and managing patients with heart failure (HF). However, there is no existing instrument for use in Chinese populations. OBJECTIVES: To translate the Minnesota Living With Heart Failure Questionnaire (MLHFQ) into a Chinese version and to validate it in the clinical setting. METHODS: This was a cross-sectional study. A convenience sample of 247 participants with New York Heart Association Class II to III chronic HF were recruited from a cardiovascular outpatient department in Taiwan. RESULTS: The content validity index was 0.98. Construct validity was supported by exploratory factor analysis, which showed three factors with 20 of 21 items loading above .50, explaining 71% of the variance. Total scale and subscale scores were correlated highly with the reference instruments, indicating satisfactory concurrent and convergent validity. The mean scores of the Chinese version of the MLHFQ were significantly higher among participants with HF than those from a non-HF comparison group. The instrument demonstrated high internal consistency (Cronbach's alpha of .95 for the scale and .93 to .95 for the subscales). CONCLUSION: The psychometric properties indicate that the Chinese version of the MLHFQ is a valid and reliable instrument for future research. This instrument provides a holistic approach for measuring health-related quality of life in New York Heart Association Class II and III HF patients.

Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure.

BACKGROUND: Previous studies demonstrated the effects of progressive muscle relaxation training (PMRT) on improvements in the health outcomes of cardiac patients. This study examined the effects of PMRT on the psychologic status and symptoms of older Chinese patients with heart failure. METHODS: In a longitudinal, randomized, and controlled study, 59 patients were allocated to receive a PMRT program and 62 were provided with the attention placebo. The PMRT program included two PMRT sessions, one revision workshop, twice-daily PMRT home practices, and a biweekly telephone follow-up call. The attention placebo included a regular telephone call at a schedule similar to that made by the interventionist of the PMRT program with the intervention group. Main outcome measures, including psychologic distress, dyspnea, and fatigue, were taken at baseline, the 8th week, and the 14th week. RESULTS: A medium effect on psychologic distress in favor of the PMRT program was detected. Patients practicing PMRT however only demonstrated a nonsignificant trend of greater improvement in symptom status. CONCLUSION: Progressive muscle relaxation training seems to be useful as an adjunctive nonpharmacologic treatment modality in the management of heart failure.

Micronutrients in African-Americans with decompensated and compensated heart failure.

Heart failure is thought to be more common and of greater severity in African-Americans (AAs). Potential mechanisms remain uncertain. The importance of micronutrient deficiencies in the pathophysiologic expression of congestive heart failure (CHF) in AAs remains to be explored, including hypovitaminosis D, which can promote secondary hyperparathyroidism (SHPT), together with hypozincemia and hyposelenemia, the 2 most crucial trace minerals integral to diverse biologic functions. Serum parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), Zn, and Se were monitored in 30 AAs hospitalized during June through December 2005, with decompensated failure and reduced ejection fraction (EF) (<35%) of predominantly nonischemic origin treated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), furosemide, and spironolactone. Based on their symptomatic status before hospitalization, 15 patients were stratified as having protracted (>or=4 weeks) CHF, whereas 15 patients had short-term (1-2 weeks) CHF. These hospitalized patients were compared with 10 AA outpatients with stable, similarly treated compensated failure and comparable EF, and 9 AA normal volunteers without cardiovascular disease. Serum PTH was elevated in all patients with protracted CHF and in 60% of patients with short-term CHF, but not in compensated patients or normal volunteers. However, serum 25(OH)D was reduced in all patients with >or=4 weeks and 80% with either 1-2 weeks CHF or compensated failure compared with volunteers. Serum Zn was below normal in 11 of 15 patients with protracted CHF, in 8 of 15 patients with shorter duration CHF, and in 5 of 10 patients with compensated failure. Serum Se was reduced in all patients with >or=4 weeks, 60% with short-term CHF, and 90% of compensated patients. Concomitant to hypovitaminosis D, hypozincemia, and hyposelenemia, SHPT is a covariant of CHF in housebound AAs.

Hypothesis: Correction of low vitamin D status among Arab women will prevent heart failure and improve cardiac function in established heart failure.

Vitamin D deficiency is common in Arab countries particularly among women. This is the result of a low dietary intake of the vitamin, limited exposure to sunlight (a paradox in view of the high sunshine figures), skin colour, obesity and high parity. Apart from its adverse effects on bone in women and their offspring, vitamin D deficiency has the potential to cause or exacerbate heart failure through a number of mechanisms including activation of the renin-angiotensin system and increased arterial pressure. Accordingly, we propose that ensuring adequate vitamin D levels in Arab women will have a much greater impact on health than just the prevention of bone disease. In particular, we suggest that prevention and correction of vitamin D deficiency will reduce the incidence of heart failure and, for Arab women with established heart failure and vitamin D deficiency, improve cardiac function.

Macro- and micronutrients in African-Americans with heart failure.

An emerging body of evidence suggests secondary hyperparathyroidism (SHPT) may be an important covariant of congestive heart failure (CHF), especially in African-Americans (AA) where hypovitaminosis D is prevalent given that melanin, a natural sunscreen, mandates prolonged exposure of skin to sunlight and where a housebound lifestyle imposed by symptomatic CHF limits outdoor activities and hence sunlight exposure. In addition to the role of hypovitaminosis D in contributing to SHPT is the increased urinary and fecal losses of macronutrients Ca(2+) and Mg(2+) associated with the aldosteronism of CHF and their heightened urinary losses with furosemide treatment of CHF. Thus, a precarious Ca(2+) balance seen with reduced serum 25(OH)D is further compromised when AA develop CHF with circulating RAAS activation and are then treated with a loop diuretic. SHPT accounts for a paradoxical Ca(2+) overloading of diverse tissues and the induction of oxidative stress at these sites which spills over to the systemic circulation. In addition to SHPT, hypozincemia and hyposelenemia have been found in AA with compensated and decompensated heart failure and where an insufficiency of these micronutrients may have its origins in inadequate dietary intake, altered rates of absorption or excretion and/or tissue redistribution, and treatment with an ACE inhibitor or AT(1) receptor antagonist. Zn and Se deficiencies, which compromise the activity of several endogenous antioxidant defenses, could prove contributory to the severity of heart failure and its progressive nature. These findings call into question the need for nutriceutical treatment of heart failure and which is complementary to today's pharmaceuticals, especially in AA.

Understanding nitric oxide physiology in the heart: a nanomedical approach.

Nitric oxide (NO) is a ubiquitous signaling molecule synthesized from L-arginine and oxygen. The process is catalyzed by NO synthase (NOS), an enzyme expressed in both constitutive (endothelial, neuronal) and inducible forms. Uncoupling of constitutive NOS leads to overproduction of superoxide (O2-) and peroxynitrite (ONOO-), 2 potent oxidants. Nanosensing techniques have been developed to monitor the physiology of NO in the beating heart in vivo. These methods involve the application of nanosensors to monitor real-time dynamics of NO production in the heart as well as the dynamics of oxidative species (oxidative stress) produced in the failing heart. Results of a recent study using nanotechnology demonstrated that African Americans have an inherent imbalance of NO, O2-, and ONOO- production in the endothelium. The overproduction of O2- and ONOO- triggers the release of aggressive radicals and damages cardiac muscle (necrosis), which may explain why African Americans are at greater risk for developing cardiovascular diseases, such as hypertension and heart failure, and are more likely to have complications than European Americans. Potential therapeutic strategies to prevent or ameliorate damage to the heart during cardiac events are prevention of O2- and ONOO- production, supplementation of NO (NO donors), and scavenging of O2- (antioxidants).