M-FADD HF Research Findings
Research findings will be posted in this section as they are available after publication. Please continue to check back as we continue to work with the study data.
Summary of research findings to date:
The M-FADD HF research study examines several key aspects of heart failure in Black adults:
These findings underscore the importance of addressing social, dietary, and stress-related factors to improve health in Black adults with heart failure. You can read more about these findings below.
- Racial Stress: Ongoing racial stress triggers immune responses, increasing inflammation, which worsens heart failure.
- Symptoms and Immune Responses: The study shows that immune responses, especially inflammation, can make heart failure symptoms worse. Chronic stress and inflammation have a strong relationship, leading to more severe symptoms.
- Neighborhood Disadvantage: Living in disadvantaged neighborhoods is linked to poor sleep and higher stress, both contributing to worse heart health.
- Diet and Inflammation: Diet plays a significant role in managing inflammation and related heart failure outcomes.
- Managing Co-occurring Conditions: Controlling diabetes and other conditions improves heart failure outcomes.
These findings underscore the importance of addressing social, dietary, and stress-related factors to improve health in Black adults with heart failure. You can read more about these findings below.
Adaptation of Metabolomics and Microbiomic Research Protocols During the COVID-19 Pandemic.
Want to learn how this study and other related studies adapted their research during COVID? Check out our paper:
Butts B, Alford T, Brewster G, et al. Adaptation of Metabolomics and Microbiomic Research Protocols During the COVID-19 Pandemic. Nurs Res. Mar-Apr 01 2022;71(2):128-137. doi:10.1097/nnr.0000000000000574
You can download the article here.
The abstract below provides an overview of the paper.
Butts B, Alford T, Brewster G, et al. Adaptation of Metabolomics and Microbiomic Research Protocols During the COVID-19 Pandemic. Nurs Res. Mar-Apr 01 2022;71(2):128-137. doi:10.1097/nnr.0000000000000574
You can download the article here.
The abstract below provides an overview of the paper.
Abstract
Background: When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University's Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection because of limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact.
Objectives: The purpose of this article is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication) and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens.
Results: Four pilot studies and two administrative supplements within the center-all at different stages of execution-adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams.
Discussion: The article concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.
Background: When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University's Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection because of limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact.
Objectives: The purpose of this article is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication) and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens.
Results: Four pilot studies and two administrative supplements within the center-all at different stages of execution-adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams.
Discussion: The article concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.
Examining the Impact of Racial Stress on Fatigue and Inflammation in Black Adults with Heart Failure: Implications for Patient Care
Hudson H, Davis E, Higgins MK, Dunbar SB, and Butts B. Examining the Impact of Racial Stress on Fatigue and Inflammation in Black Adults with Heart Failure: Implications for Patient Care.
This abstract was presented by BSN Honors student, Hannah Hudson, at the Preventive Cardiovascular Nurses Association 2024 in Orlando, FL.
Abstract
Background: Black adults have a higher risk of heart failure (HF), with earlier onset and worse outcomes than other populations. Structural inequalities affect disease prognosis due to increased inflammation that worsens HF symptoms, likely linked to chronic stress resulting from racial discrimination. The role of racial stress on patient-reported outcomes in Black persons with HF is not well understood. The purpose of this study is to examine the connection between racial stress, inflammation (interleukin [IL]-1b and IL-6), and symptoms in Black adults with HF.
Methods: Black adults with HF (N=41) were enrolled in this cross-sectional study. IL1-b and IL-6 were self-collected via Mitra microsampling and analyzed by immunoassay. Measures included Index of Race Related Stress Brief (IRRS), HF Somatic Perception Scale (HFSPS), RAND 36-Item Health Survey (SF-36), Multidimensional Fatigue Inventory (MFI), and PROMIS Dyspnea Severity. Linear regression analyses, controlling for ejection fraction, age, gender, and comorbidities, were performed.
Results: Participants were 57±12 years of age and 66% female. Total racial stress was positively associated with chest pain (b=.390, p=.049) and IL1-b (b=.480, p=.024). Institutional racial stress was positively associated with MFI general fatigue (b=.494, p=.014), MFI physical fatigue (b=.605, p=.003), MFI reduced motivation (b=.452, p=.035), MFI mental fatigue (b=.527, p=.004), HFSPS total (b=.426, p=.021), HFSPS chest pain (b=.509, p=.008), and IL1-b (b=.523, p=.012) and negatively associated with SF-36 measures of physical functioning (b=-.509, p=.010), ability to perform daily activity (b=-.563, p=.005), and social functioning (b=-.449, p=.041). Individual racial stress was associated with dyspnea (b=.445, p=.019) and HFSPS chest pain (b=.573, p=.001). No associations with IL-6 were found.
Conclusion: Experienced racial stress was associated with higher physical and mental fatigue, chest pain, and IL1-b levels and lower physical functioning, suggesting the detrimental effects of racial stress on symptom severity and inflammation in Black adults with HF. A better understanding of how structural racism impacts the experience of HF in Black adults is needed to enhance patient care.
Background: Black adults have a higher risk of heart failure (HF), with earlier onset and worse outcomes than other populations. Structural inequalities affect disease prognosis due to increased inflammation that worsens HF symptoms, likely linked to chronic stress resulting from racial discrimination. The role of racial stress on patient-reported outcomes in Black persons with HF is not well understood. The purpose of this study is to examine the connection between racial stress, inflammation (interleukin [IL]-1b and IL-6), and symptoms in Black adults with HF.
Methods: Black adults with HF (N=41) were enrolled in this cross-sectional study. IL1-b and IL-6 were self-collected via Mitra microsampling and analyzed by immunoassay. Measures included Index of Race Related Stress Brief (IRRS), HF Somatic Perception Scale (HFSPS), RAND 36-Item Health Survey (SF-36), Multidimensional Fatigue Inventory (MFI), and PROMIS Dyspnea Severity. Linear regression analyses, controlling for ejection fraction, age, gender, and comorbidities, were performed.
Results: Participants were 57±12 years of age and 66% female. Total racial stress was positively associated with chest pain (b=.390, p=.049) and IL1-b (b=.480, p=.024). Institutional racial stress was positively associated with MFI general fatigue (b=.494, p=.014), MFI physical fatigue (b=.605, p=.003), MFI reduced motivation (b=.452, p=.035), MFI mental fatigue (b=.527, p=.004), HFSPS total (b=.426, p=.021), HFSPS chest pain (b=.509, p=.008), and IL1-b (b=.523, p=.012) and negatively associated with SF-36 measures of physical functioning (b=-.509, p=.010), ability to perform daily activity (b=-.563, p=.005), and social functioning (b=-.449, p=.041). Individual racial stress was associated with dyspnea (b=.445, p=.019) and HFSPS chest pain (b=.573, p=.001). No associations with IL-6 were found.
Conclusion: Experienced racial stress was associated with higher physical and mental fatigue, chest pain, and IL1-b levels and lower physical functioning, suggesting the detrimental effects of racial stress on symptom severity and inflammation in Black adults with HF. A better understanding of how structural racism impacts the experience of HF in Black adults is needed to enhance patient care.
Sex Differences in Relationships Between Inflammation and Symptoms in Persons with Heart Failure
Butts B, Davis E, Morris AA, Dunbar SB. Abstract 12479: Cardiovascular Stroke Nursing Best Abstract Award: Sex Differences in Relationships Between Inflammation and Symptoms in Persons With Heart Failure. Circulation. 2023;148(Suppl_1):A12479. doi:doi:10.1161/circ.148.suppl_1.12479.
Abstract
Background Heart failure (HF) is a complex syndrome involving interplay of pathologic processes, such as inflammation and myocardial remodeling. Sex differences in cardiac remodeling and function are linked to differences in inflammation. Female hearts show a pro-inflammatory shift and increased cytokine expression with aging not seen in male hearts. Yet, sex is not often considered in HF interventions. Previous studies suggest sex may moderate the relationship between inflammation and symptoms in cardiometabolic disease, but the relationship in HF is unknown.
Purpose: To examine sex differences in inflammation and symptoms in Black adults living with HF.
Methods: Black adults living with HF (N=41) were enrolled in this pilot study. Physical symptoms were measured with PROMIS Dyspnea, Heart Failure Somatic Perception Scale (HFSPS), and Multidimensional Fatigue Inventory (MFI). Mood symptoms were measured with Center for Epidemiological Studies Depression Scale (CESD), State-Trait Anxiety Inventory (STAI), and Perceived Stress Scale (PSS). Inflammatory biomarkers were measured via multiplex immunoassay. Xanthine oxidase (XO) activity, an indicator of oxidative stress, was measured via ELISA. Pearson correlations were stratified by sex.
Results: The mean age was 57 ± 11 years, and 66% were female. Dyspnea was positively associated with XO activity in both groups. Among females, dyspnea was positively associated with matrix metalloproteinase (MMP)-12 (r=.519, p=.033), interleukin (IL)-6 (p=.564, p=.018), [C-C motif chemokine ligand(CCL)-3, (r=.509, p=.037), and CCL-11 (r=.520, p=.032). HFSPS was positively associated with XO activity among females only (r=.445, p=.014). CCL-11 was positively associated with MFI (r=.616, p=.008), PSS (p=.0537, r=.032), STAI (r=.714, p=.001), and CESD (r=.635, p=.008) symptoms among females but not males.
Conclusions: While physical symptoms were associated with similar inflammatory pathways, fatigue and mood symptoms were associated with inflammation among females only. Women may be more vulnerable to inflammation-induced mood changes and fatigue. Further work is needed to better understand how sex modulates the relationship between inflammation and symptoms in persons with HF.
Background Heart failure (HF) is a complex syndrome involving interplay of pathologic processes, such as inflammation and myocardial remodeling. Sex differences in cardiac remodeling and function are linked to differences in inflammation. Female hearts show a pro-inflammatory shift and increased cytokine expression with aging not seen in male hearts. Yet, sex is not often considered in HF interventions. Previous studies suggest sex may moderate the relationship between inflammation and symptoms in cardiometabolic disease, but the relationship in HF is unknown.
Purpose: To examine sex differences in inflammation and symptoms in Black adults living with HF.
Methods: Black adults living with HF (N=41) were enrolled in this pilot study. Physical symptoms were measured with PROMIS Dyspnea, Heart Failure Somatic Perception Scale (HFSPS), and Multidimensional Fatigue Inventory (MFI). Mood symptoms were measured with Center for Epidemiological Studies Depression Scale (CESD), State-Trait Anxiety Inventory (STAI), and Perceived Stress Scale (PSS). Inflammatory biomarkers were measured via multiplex immunoassay. Xanthine oxidase (XO) activity, an indicator of oxidative stress, was measured via ELISA. Pearson correlations were stratified by sex.
Results: The mean age was 57 ± 11 years, and 66% were female. Dyspnea was positively associated with XO activity in both groups. Among females, dyspnea was positively associated with matrix metalloproteinase (MMP)-12 (r=.519, p=.033), interleukin (IL)-6 (p=.564, p=.018), [C-C motif chemokine ligand(CCL)-3, (r=.509, p=.037), and CCL-11 (r=.520, p=.032). HFSPS was positively associated with XO activity among females only (r=.445, p=.014). CCL-11 was positively associated with MFI (r=.616, p=.008), PSS (p=.0537, r=.032), STAI (r=.714, p=.001), and CESD (r=.635, p=.008) symptoms among females but not males.
Conclusions: While physical symptoms were associated with similar inflammatory pathways, fatigue and mood symptoms were associated with inflammation among females only. Women may be more vulnerable to inflammation-induced mood changes and fatigue. Further work is needed to better understand how sex modulates the relationship between inflammation and symptoms in persons with HF.
Heart Failure Symptoms Are Associated With Markers of T Cell Activation and Tissue Remodeling
Butts B, Davis E, Morris AA, Dunbar SB. Abstract 14816: Heart Failure Symptoms Are Associated With Markers of T Cell Activation and Tissue Remodeling. Circulation. 2022;146(Suppl_1):A14816-A14816. doi:doi:10.1161/circ.146.suppl_1.14816
The abstract below, which was presented at the American Heart Association Scientific Sessions 2022 in Chicago, IL, are preliminary findings. Final results related to these data are in progress, and will be submitted for publication.
The abstract below, which was presented at the American Heart Association Scientific Sessions 2022 in Chicago, IL, are preliminary findings. Final results related to these data are in progress, and will be submitted for publication.
Abstract
Introduction: Heart failure (HF) is a complex syndrome involving the interplay of pathophysiologic processes, such as inflammation and myocardial remodeling. T cell activation contributes to HF progression through cytokine release leading to cardiac fibrosis and hypertrophy. HF is characterized by physical symptoms that have been shown to predict morbidity and mortality. However, the pathophysiologic mechanisms driving symptoms are not well understood. Despite disparities in HF severity and morbidity among Black adults, relationships between inflammation and symptom burden are not well characterized in this population.
Hypothesis: HF physical symptoms are positively associated with T-cell associated cytokines and chemokines.
Methods: Black adults with HF (N=30) and LVEF <50% were enrolled in this study. Symptoms were assessed with the PROMIS Dyspnea Severity Short Form 10a and Heart Failure Somatic Perception Scale (HFSPS). Biomarkers were measured via multiplex immunoassay.
Results: The mean age was 55.38 ± 12.4 years, and 67% were female. Mean LVEF was 30 ± 13%. Dyspnea severity was positively associated with matrix metalloproteinase (MMP)-1 (r=0.412, p=0.041) and MMP-12 (r=0.496, p=0.014). HFSPS was positively related to cytokines associated with T-cell activation and differentiation [interleukin (IL)-1β (r=0.526, p=0.007), IL-6 (p=0.510, p=0.011), and IL-15 (p=0.528, p=0.019)], and with chemokines involved in T cell recruitment [C-C motif chemokine ligand(CCL)-11 (r=0.399, p=0.048), CCL-19 (r=0.421, p=0.036), C-X-C motif chemokine ligand (CXCL)-8 (r=0.528, p=0.007), and CXCL-11 (r=0.418, p=0.037)].
Conclusions: Somatic symptoms were associated with T cell-related cytokines and chemokines. Dyspnea was associated with enzymes that promote tissue remodeling and breakdown of collagen and elastin. These findings suggest tissue remodeling may play a role in HF symptoms, providing a potential therapeutic target for attenuating factors associated with HF symptom burden. Considering the pleiotropic nature of cytokines, further mechanistic work is needed for a better understanding of the pathophysiologic processes that could be targeted with interventions to reduce symptom burden in persons with HF.
Introduction: Heart failure (HF) is a complex syndrome involving the interplay of pathophysiologic processes, such as inflammation and myocardial remodeling. T cell activation contributes to HF progression through cytokine release leading to cardiac fibrosis and hypertrophy. HF is characterized by physical symptoms that have been shown to predict morbidity and mortality. However, the pathophysiologic mechanisms driving symptoms are not well understood. Despite disparities in HF severity and morbidity among Black adults, relationships between inflammation and symptom burden are not well characterized in this population.
Hypothesis: HF physical symptoms are positively associated with T-cell associated cytokines and chemokines.
Methods: Black adults with HF (N=30) and LVEF <50% were enrolled in this study. Symptoms were assessed with the PROMIS Dyspnea Severity Short Form 10a and Heart Failure Somatic Perception Scale (HFSPS). Biomarkers were measured via multiplex immunoassay.
Results: The mean age was 55.38 ± 12.4 years, and 67% were female. Mean LVEF was 30 ± 13%. Dyspnea severity was positively associated with matrix metalloproteinase (MMP)-1 (r=0.412, p=0.041) and MMP-12 (r=0.496, p=0.014). HFSPS was positively related to cytokines associated with T-cell activation and differentiation [interleukin (IL)-1β (r=0.526, p=0.007), IL-6 (p=0.510, p=0.011), and IL-15 (p=0.528, p=0.019)], and with chemokines involved in T cell recruitment [C-C motif chemokine ligand(CCL)-11 (r=0.399, p=0.048), CCL-19 (r=0.421, p=0.036), C-X-C motif chemokine ligand (CXCL)-8 (r=0.528, p=0.007), and CXCL-11 (r=0.418, p=0.037)].
Conclusions: Somatic symptoms were associated with T cell-related cytokines and chemokines. Dyspnea was associated with enzymes that promote tissue remodeling and breakdown of collagen and elastin. These findings suggest tissue remodeling may play a role in HF symptoms, providing a potential therapeutic target for attenuating factors associated with HF symptom burden. Considering the pleiotropic nature of cytokines, further mechanistic work is needed for a better understanding of the pathophysiologic processes that could be targeted with interventions to reduce symptom burden in persons with HF.
Area Deprivation Index, Symptoms, and Biomarkers Among Black and African Americans Living with Heart Failure
Herring CH, Davis E, Higgins MK, Morris A, Dunbar SB, Butts B. Abstract 12661: Area Deprivation Index, Symptoms, and Biomarkers Among Black and African Americans Living With Heart Failure. Circulation. 2023;148(Suppl_1):A12661. doi:doi:10.1161/circ.148.suppl_1.12661.
Presented by PhD student, Hayden Herring, at the American Heart Association Scientific Sessions 2023 in Philadelphia, PA.
Presented by PhD student, Hayden Herring, at the American Heart Association Scientific Sessions 2023 in Philadelphia, PA.
Abstract
Introduction: Heart failure (HF) is a complex chronic condition that disproportionally affects Black adults. Social determinants of health, such as the lived environment and socioeconomic status, contribute to higher incidence and poorer outcomes, including higher stress and poorer sleep in this population. This study aims to examine the relationship between neighborhood socioeconomic disadvantage with symptoms, and inflammatory and cardiometabolic markers in Black adults living with HF.
Methods: A secondary analysis of a pilot study that enrolled self-identified Black adults living with HF was performed (N=41, 57 ± 11 years of age, 66% women). Neighborhood socioeconomic disadvantage was measured by Area Deprivation Index (ADI) national and state rankings generated from the Neighborhood Atlas; higher scores reflect higher neighborhood disadvantage. Questionnaires included Perceived Stress Scale (PSS) and PROMIS Sleep Disturbance. Inflammatory and cardiometabolic biomarkers were measured via immunoassay. Spearman correlation analyses were performed.
Results: Mean ADI scores were 61.23 ± 21.1 (national) and 5.7 ± 2.4 (state). National and State ADI scores were positively associated with both PSS (ρ=.584, p<.001; ρ=.551, p<.001) and PROMIS Sleep Disturbance (ρ=.486, p=.04; ρ =.551, p=<.001), respectively. Additionally, National and State ADI scores were positively associated with inflammatory cytokines IL-4 (ρ=.345, p=.031; ρ=.371, p=.020) and IL-18 (ρ=.408, p=.009; ρ=.392, p=.012). National and State ADI scores were also related to cardiometabolic biomarkers VCAM-1 (ρ=.360, p=.022; ρ=.363, p=.021) and C1QNTF1 (ρ=.483, p=.002; ρ=.447, p=.004). No significant association was found between ADI scores and demographics.
Discussion: These findings suggest higher ADI scores are associated with higher perceived stress, sleep disturbance, and inflammatory and cardiometabolic biomarkers among Black adults living with HF. These results highlight the potential role neighborhood socioeconomic status contributes to adverse health outcomes in this population. Further research is warranted to identify mechanisms contributing to these relationships and to develop and test approaches to reduce the impact of health disparities in HF.
Introduction: Heart failure (HF) is a complex chronic condition that disproportionally affects Black adults. Social determinants of health, such as the lived environment and socioeconomic status, contribute to higher incidence and poorer outcomes, including higher stress and poorer sleep in this population. This study aims to examine the relationship between neighborhood socioeconomic disadvantage with symptoms, and inflammatory and cardiometabolic markers in Black adults living with HF.
Methods: A secondary analysis of a pilot study that enrolled self-identified Black adults living with HF was performed (N=41, 57 ± 11 years of age, 66% women). Neighborhood socioeconomic disadvantage was measured by Area Deprivation Index (ADI) national and state rankings generated from the Neighborhood Atlas; higher scores reflect higher neighborhood disadvantage. Questionnaires included Perceived Stress Scale (PSS) and PROMIS Sleep Disturbance. Inflammatory and cardiometabolic biomarkers were measured via immunoassay. Spearman correlation analyses were performed.
Results: Mean ADI scores were 61.23 ± 21.1 (national) and 5.7 ± 2.4 (state). National and State ADI scores were positively associated with both PSS (ρ=.584, p<.001; ρ=.551, p<.001) and PROMIS Sleep Disturbance (ρ=.486, p=.04; ρ =.551, p=<.001), respectively. Additionally, National and State ADI scores were positively associated with inflammatory cytokines IL-4 (ρ=.345, p=.031; ρ=.371, p=.020) and IL-18 (ρ=.408, p=.009; ρ=.392, p=.012). National and State ADI scores were also related to cardiometabolic biomarkers VCAM-1 (ρ=.360, p=.022; ρ=.363, p=.021) and C1QNTF1 (ρ=.483, p=.002; ρ=.447, p=.004). No significant association was found between ADI scores and demographics.
Discussion: These findings suggest higher ADI scores are associated with higher perceived stress, sleep disturbance, and inflammatory and cardiometabolic biomarkers among Black adults living with HF. These results highlight the potential role neighborhood socioeconomic status contributes to adverse health outcomes in this population. Further research is warranted to identify mechanisms contributing to these relationships and to develop and test approaches to reduce the impact of health disparities in HF.
Connections Between the Western Diet and Inflammation in Heart Failure
Davis E, Dunbar SB, Higgins M, Wood KA, Morris AA, Butts B. Abstract 15795: Connections Between the Western Diet and Inflammation in Heart Failure. Circulation. 2022;146(Suppl_1):A15795-A15795. doi:doi:10.1161/circ.146.suppl_1.15795
This abstract was presented by postdoctoral fellow, Erica Davis, at the American Heart Association Scientific Sessions 2022 in Chicago, IL.
This abstract was presented by postdoctoral fellow, Erica Davis, at the American Heart Association Scientific Sessions 2022 in Chicago, IL.
Abstract
Introduction: The Western Diet (WD) is associated with deleterious processes linked with chronic disease and may play a role in the pathophysiology of heart failure (HF). Trimethylamine-N-oxide (TMAO) is a diet-linked metabolite that contributes to inflammation and is associated with higher TNF-α, especially in HF populations. The dietary inflammatory index (DII) score measures the inflammatory potential of a diet and the inflammatory effects of foods. More studies are needed to determine how the WD impacts immunological pathways and cytokines in the context of clinical and population characteristics.
Purpose: The aim of this study was to explore associations between the WD, DII, TMAO, and TNF-α in Black patients living with HF.
Methods: Thirty Black participants (mean age 55.3, 67.7% women) with HF were included in this study. TMAO and TNF-α levels were analyzed from dried blood spots using immunoassays. Participants completed a Food Frequency Questionnaire (FFQ) from which a DII score was derived. Food groups and nutrients, like choline, were measured with the FFQ. Sociodemographic variables were measured. Analyses included correlational and inferential statistics.
Results: Mean DII score was -.38 revealing an overall anti-inflammatory diet with higher inflammatory scores among men (-.23) as compared to women (-.43). Women consumed greater kilocalories with more saturated fat, sodium, dairy, sugar, and fruit while men consumed more cholesterol, choline, proteins, alcohol, legumes, poultry, red meats, eggs, and phosphatidylcholine. DII score was negatively correlated with dietary choline (r= -.73, p<.001), but did not correlate with TMAO or TNF-α. TNF-α and TMAO were positively related (r=.30, p=.057).
Conclusions: This sample of well-educated HF patients from a busy HF referral center did not consume a highly pro-inflammatory diet, yet our findings provide insight for specific food groups such as those with choline. In patients with HF, it is important to monitor intake of inflammatory foods and appreciate that increasing age may play a role in the retention of dietary metabolites. Further study of these relationships in patients with HF could lead to tailored dietary educational interventions based on dietary patterns, age, and cultural relevance.
Introduction: The Western Diet (WD) is associated with deleterious processes linked with chronic disease and may play a role in the pathophysiology of heart failure (HF). Trimethylamine-N-oxide (TMAO) is a diet-linked metabolite that contributes to inflammation and is associated with higher TNF-α, especially in HF populations. The dietary inflammatory index (DII) score measures the inflammatory potential of a diet and the inflammatory effects of foods. More studies are needed to determine how the WD impacts immunological pathways and cytokines in the context of clinical and population characteristics.
Purpose: The aim of this study was to explore associations between the WD, DII, TMAO, and TNF-α in Black patients living with HF.
Methods: Thirty Black participants (mean age 55.3, 67.7% women) with HF were included in this study. TMAO and TNF-α levels were analyzed from dried blood spots using immunoassays. Participants completed a Food Frequency Questionnaire (FFQ) from which a DII score was derived. Food groups and nutrients, like choline, were measured with the FFQ. Sociodemographic variables were measured. Analyses included correlational and inferential statistics.
Results: Mean DII score was -.38 revealing an overall anti-inflammatory diet with higher inflammatory scores among men (-.23) as compared to women (-.43). Women consumed greater kilocalories with more saturated fat, sodium, dairy, sugar, and fruit while men consumed more cholesterol, choline, proteins, alcohol, legumes, poultry, red meats, eggs, and phosphatidylcholine. DII score was negatively correlated with dietary choline (r= -.73, p<.001), but did not correlate with TMAO or TNF-α. TNF-α and TMAO were positively related (r=.30, p=.057).
Conclusions: This sample of well-educated HF patients from a busy HF referral center did not consume a highly pro-inflammatory diet, yet our findings provide insight for specific food groups such as those with choline. In patients with HF, it is important to monitor intake of inflammatory foods and appreciate that increasing age may play a role in the retention of dietary metabolites. Further study of these relationships in patients with HF could lead to tailored dietary educational interventions based on dietary patterns, age, and cultural relevance.
Comorbid Diabetes Is Associated with Dyspnea Severity and Cardiometabolic Biomarkers in Black Adults with Heart Failure
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Butts B, Kamara J, Morris AA, Davis E, Higgins MK, and Dunbar SB. Comorbid Diabetes Is Associated with Dyspnea Severity and Cardiometabolic Biomarkers in Black Adults with Heart Failure. Nursing Research. In Press This abstract was presented by undergraduate student, Julia Kamara, at the Preventive Cardiovascular Nurses Association 2024 in Orlando, FL. |
Abstract
Background: Comorbidities such as type II diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied.
Objectives: The purpose of this pilot study is to examine differences in the distressing heart failure symptom of dyspnea and cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes.
Methods: Black adults living with heart failure (N=41) were enrolled in this pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes (n=15) and those without (n=26), controlling for age, sex, and comorbid burden.
Results: Participants were mostly female (66%), with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers.
Discussion: Comorbid diabetes was independently associated with increased dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities.
Background: Comorbidities such as type II diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied.
Objectives: The purpose of this pilot study is to examine differences in the distressing heart failure symptom of dyspnea and cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes.
Methods: Black adults living with heart failure (N=41) were enrolled in this pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes (n=15) and those without (n=26), controlling for age, sex, and comorbid burden.
Results: Participants were mostly female (66%), with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers.
Discussion: Comorbid diabetes was independently associated with increased dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities.