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CLINICAL RESEARCH: HEART FAILURE

African-American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy

Mindy B. Gentry, MD^_*,_*, James K. Dias, PhD, Antonio Luis, MD^_*, Rakesh Patel, MD^_*, John Thornton, MD^_* and Guy L. Reed, MD^_*,

^_* Cardiovascular Center, Department of Medicine, Medical College of Georgia, Augusta, Georgia
Department of Biostatistics, Medical College of Georgia, Augusta, Georgia
Department of Medicine, University of Tennessee, Memphis, Tennessee

Manuscript received June 3, 2009; revised manuscript received August 26, 2009, accepted September 21, 2009.

^_* Reprint requests and correspondence: Dr. Mindy B. Gentry, MCG Cardiovascular Center, 1120 15th Street, BBR 6517, Augusta, Georgia 30912 (Email: mgentry{at}mcg.edu).

Objectives: The purpose of this study was to assess whether African-American women are at increased risk of having peripartum cardiomyopathy.

Background: Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions.

Methods: A case-control study was performed at a regional center that provides medical care to a racially heterogeneous population. For each case, 3 healthy control patients were randomly selected who delivered babies within the same month.

Results: African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non–African Americans (odds ratio [OR]: 15.7, 95% confidence interval [CI]: 3.5 to 70.6). Other significant univariate risk factors were hypertension (OR: 10.8, 95% CI: 2.6 to 44.4), being unmarried (OR: 4.2, 95% CI: 1.4 to 12.3), and having had >2 previous pregnancies (OR: 2.9, 95% CI: 1.1 to 7.4). African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable (OR: 31.5, 95% CI: 3.6 to 277.6) and stratified analyses (OR: 12.9 to 29.1, p < 0.001). Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women.

Conclusions: African-American women have significantly higher odds of having peripartum cardiomyopathy that could not be explained by several other factors. Further research will be necessary to determine the potential environmental and/or genetic factors associated with African descent that confer this risk.

Key Words: heart failure • pregnancy • race

Abbreviations and Acronyms   HF = heart failure   MCG = Medical College of Georgia   OR = odds ratio

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