A large, long-term observational study led by researchers from the U.S. National Heart, Lung, and Blood Institute (NHLBI) has revealed that the risk of having heart failure is higher among people in rural areas in America.
Heart Failure
Heart failure occurs when the heart is unable to supply sufficient blood for the needs of the body. It is a progressive condition that presents symptoms including breathing difficulty and shortness of breath. More than six million adults in the U.S. are believed to be affected.
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This new research is the first to probe the connection between living in a rural area and developing heart failure. It also shows that being a Black male further increases the risk.
The researchers noted that their findings highlight the need to adopt better-customized methods for preventing heart failure among people in rural areas, especially Black men.
The results of the long-term study were published in the journal JAMA Cardiology.
Higher heart failure risk
In this work that was co-led by researchers from the Nashville, Tennessee-based Vanderbilt University Medical Center, the team examined data from a long-term adult health study in the southeastern United States. The study called The Southern Community Cohort Study included more than 27,000 adults who had no heart failure when enrolled. These subjects were tracked for around 13 years.
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The researchers probed and compared new heart failure rates among people living in rural and urban areas in 12 states, including Florida, Georgia, Tennessee, and Virginia. Almost 20 percent of these people lived in rural areas and nearly 69 percent were Black adults.
Following its analysis, the research team calculated heart failure risk to be roughly 19 percent higher among rural residents compared to urban residents.
The researchers found that being female or Black male living in a rural area could mean a greater risk of heart failure. Black men that are residents in rural areas showed the highest risk overall at 34 percent higher than counterparts in urban areas. White women in rural areas had a 22 percent higher risk than urban-dwelling White women.
The risk remained higher even after adjusting for socioeconomic status and other cardiovascular risk factors.
“Finding an association between living in rural areas and an increased incidence of heart failure is an important advance, especially given its implications for helping to address geographic-, gender-, and race-based disparities,” said David Goff, director of the Division of Cardiovascular Sciences at the NHLBI.
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As for rural Black women, they displayed an 18 percent higher risk than Black women living in urban areas. The team did not observe a relationship between the area of residence and the risk of heart failure among White men.
Unknown reasons
Researchers in this study did not foresee what they found. They were not expecting a person’s area of residence to have such a significant effect on their risk of having heart failure, especially among Black men.
The team could not tell what was responsible for the observed differences. Researchers are still struggling to work out the reasons.
However, several factors have been suggested as possibly being to blame. They include structural racism and unequal access to healthcare. Another probable explanation is a shortage of grocery stores to make available low-priced, healthy foods in rural areas.
Researchers say high blood pressure or hypertension plays a major role in the incidence of heart failure. This may explain why Black men had the highest risk in the study – hypertension affects this group greatly.
With only a few treatment options available, prevention remains the best approach for tackling heart failure. The condition can be averted by adopting a lifestyle that is heart-friendly, including eating a healthy diet, doing regular exercise, and avoiding tobacco.
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The risk of heart failure can be reduced by regularly monitoring blood pressure and using prescribed medicine.
“It is much easier to prevent heart failure than to reduce its mortality once you have it,” said Sarah Turecamo, study co-author and a medical student at NYU Grossman School of Medicine.
The researchers look forward to studies in the future that would test interventions to tackle heart failure among rural residents.
