Factors associated with isolated right heart failure in women: a pilot study from western Kenya.
Abstract
BACKGROUND: Small observational studies have found that isolated right heart failure
(IRHF) is prevalent among women of sub-Saharan Africa. Further, several risk factors
for the development of IRHF have been identified. However, no similar studies have
been conducted in Kenya. OBJECTIVE: We hypothesized that specific environmental exposures
and comorbidities were associated with IRHF in women of western Kenya. METHODS: We
conducted a case-control study at a referral hospital in western Kenya. Cases were
defined as women at least 35 years old with IRHF. Control subjects were similarly
aged volunteers without IRHF. Exclusion criteria in both groups included history of
tobacco use, tuberculosis, or thromboembolic disease. Participants underwent echocardiography,
spirometry, 6-min walk test, rest/exercise oximetry, respiratory health interviews,
and human immunodeficiency virus (HIV) testing. Home visits were performed to evaluate
kitchen ventilation, fuel use, and cook smoke exposure time, all surrogate measures
of indoor air pollution (IAP). A total of 31 cases and 65 control subjects were enrolled.
Surrogate measures of indoor air pollution were not associated with IRHF. However,
lower forced expiratory volume at 1 s percent predicted (adjusted odds ratio [AOR]:
2.02, 95% confidence interval [CI]: 1.27 to 3.20; p = 0.004), HIV positivity (AOR:
40.4, 95% CI: 3.7 to 441; p < 0.01), and self-report of exposure to occupational dust
(AOR: 3.9, 95% CI: 1.14 to 14.2; p = 0.04) were associated with IRHF. In an analysis
of subgroups of participants with and without these factors, lower kitchen ventilation
was significantly associated with IRHF among participants without airflow limitation
(AOR: 2.63 per 0.10 unit lower ventilation, 95% CI: 1.06 to 6.49; p = 0.04), without
HIV (AOR: 2.55, 95% CI: 1.21 to 5.37; p = 0.02), and without occupational dust exposure
(AOR: 2.37, 95% CI: 1.01 to 5.56; p = 0.05). CONCLUSIONS: In this pilot study among
women of western Kenya, lower kitchen ventilation, airflow limitation, HIV, and occupational
dust exposure were associated with IRHF, overall or in participant subgroups. Direct
or indirect causality requires further study.
Type
Journal articleSubject
AdultAged
Aged, 80 and over
Case-Control Studies
Female
Heart Failure
Humans
Kenya
Middle Aged
Pilot Projects
Risk Factors
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https://hdl.handle.net/10161/15034Published Version (Please cite this version)
10.1016/j.gheart.2014.04.003Publication Info
Lagat, David K; DeLong, Allison K; Wellenius, Gregory A; Carter, E Jane; Bloomfield,
Gerald S; Velazquez, Eric J; ... Sherman, Charles B (2014). Factors associated with isolated right heart failure in women: a pilot study from
western Kenya. Glob Heart, 9(2). pp. 249-254. 10.1016/j.gheart.2014.04.003. Retrieved from https://hdl.handle.net/10161/15034.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Gerald Bloomfield
Associate Professor of Medicine
Eric J. Velazquez
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University.
As section chief for Cardiovascular Imaging in the Division of Cardiology and director
of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University
Health System, he coordinates a high-volume enterprise and an outstanding group of
clinician-investigators and clinical staff who make important contributions across
patient care, research and educational
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