{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T03:18:08Z","timestamp":1780370288032,"version":"3.54.1"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,5,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993\u20131996, median age 58\u00a0years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1)\n              <jats:italic>Stage 0<\/jats:italic>\n              : no risk factors; (2)\n              <jats:italic>Stage A<\/jats:italic>\n              : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural\/functional abnormality; (3)\n              <jats:italic>Stage B<\/jats:italic>\n              : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4)\n              <jats:italic>Stage C\/D<\/jats:italic>\n              : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all\u2010cause mortality on follow\u2010up according to HF stage. The prevalence of HF Stages 0, A, B, and C\/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow\u2010up (median 19.0\u00a0years), 309 participants developed overt HF, 390 incurred new\u2010onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person\u2010years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5\u2010 to 2\u2010fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0\/A.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In our large community\u2010based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016524","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T10:35:26Z","timestamp":1619001326000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Epidemiology of Heart Failure Stages in Middle\u2010Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities 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Bloomberg School of Public Health Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Beard","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Mississippi Medical Center Jackson MS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olushola B.","family":"Obafemi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Mississippi Medical Center Jackson MS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3198-8835","authenticated-orcid":false,"given":"Kenneth R.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Mississippi Medical Center Jackson MS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia P.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine University of North Carolina at 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