Metabolomic Pathways to Symptoms in Black Adults with Heart Failure
Metabolomic Pathways to Fatigue, Anxiety, Depression, and Dyspnea in Black Adults with Heart Failure and Hypertension. (MFADD-HF)
Heart failure is the only cardiovascular disease increasing in prevalence; over 6.5 million Americans are living with HF. Black adults have the highest risk of developing HF, with an earlier HF onset, more severe left ventricular (LV) dysfunction, and more advanced disease severity, all leading to a higher HF morbidity. Hypertension (HTN) is the etiology in >50% of Black adults with HF, and represents the strongest risk factor for HF. The prevalence of HTN among Black adults in the US is among the highest in the world. Although Black adults have the highest death rate for heart failure, they are consistently underrepresented in clinical trials. Considering the greater HF burden among Black adults, further work is needed to discover effective therapeutic targets for this higher-risk population.
This pilot study examines the specific and distressing symptoms of fatigue, depression, anxiety, and dyspnea in Black adults living with HF and HTN, focusing on how individual, biological, and behavioral factors relate to symptoms and symptom clusters and how metabolites and metabolic pathways are associated with these symptoms. The specific aims of this study are: 1. examine the associations among the circulating metabolites and metabolic profiles with the severity of each of the symptoms of fatigue, depression, or anxiety, and compare the circulating metabolites and metabolic pathways that associate with symptom severity in participants with HF versus participants with that HF plus HTN at baseline and 3 months; 2. identify the relationships among demographic, clinical, psychosocial and behavioral covariates (e.g., sex as a biological variable, body mass index, stress, SES, diet, smoking, medications, comorbidities, disease severity), metabolites and metabolic pathways, severity levels of symptoms of fatigue, depression, or anxiety, symptom synergy and heath related quality of life at baseline and 3 months. In addition, an exploratory aim explores the contribution of the gut microbiome and microbiome-associated metabolites and metabolic pathways as potential covariates associated with self-report of severity of symptoms of fatigue, depression, and anxiety at baseline and 3 months. This study will advance our understanding of symptoms to address the gaps in knowledge that will lead to more precise symptom-reducing interventions in HF. The findings from this study will inform future work to improve outcomes in Black adults with HF, and hopefully work towards lessening the disparities in morbidity and mortality experienced by this population.
Funding: National Institute of Nursing Research P30NR018090 (6/2020 - 5/2022)