Cardiovascular risk in special populations IV: Congenital heart defects.

Abstract

Congenital heart defects are found in approximately 1 in 100 to 150 newborns and are associated with racial disparities in types, interventions, and mortality. Although mortality from heart defects between 1979 and 1997 in the United States for all ages declined 39% (from 2.5 to 1.5 per 100,000 population) and in a similar percentage for infants, mortality was 19% higher in blacks than whites, 68.4 vs 55.5 per 100,000, respectively. In regard to infants, mortality has decreased considerably in this 18-year period for such major congenital heart disease as transposition of the great arteries, ventricular septal defect (VSD), atrioventricular septal defect, and aortic coarctation. Moreover, although mortality decreased in blacks as well as white infants, black infant mortality rates were consistently higher during this period (Figure 1). Overall, the average age of death increased for the common congenital heart defects during this 18-year period but was higher in blacks. The changes for some common congenital heart conditions can be see in Table I. For all common congenital heart defects, between 1979–1983 and 1994–1997, the 50th percentile in mortality for whites increased from 7 months to 12 months, and for blacks only from 3 months to 5 months. For most anomalies, although the median and especially 75th percentile ages increased considerably, black mortality persisted at a younger age than whites for virtually all categories (Table II). Categories in which deaths in blacks occurred at least at one half the age as whites or lower included VSD, aortic and pulmonic valve anomalies, and single ventricle. Access to medical care, nutrition, and maternal lifestyles and education may be responsible for neural tube defects. Higher rates of neural tube defects were found in Hispanic women in Brooklyn than black or non-Hispanic whites. Racial variations in congenital defects appear to vary widely among blacks and whites in a study from Atlanta, Georgia. Congenital heart defects were found to be more common in American Indians in British Columbia than in the general population. Fetal alcohol syndrome may be associated with congenital heart anomalies and the syndrome is particularly common in Native Americans, occurring in up to 103 of 100,000 live births. On the basis of a populationbased case control study of congenital cardiovascular malformations in the Washington, DC and widespread surrounding area between 1981–1987, birth weight deficits were found for infants with tetralogy of Fallot, endocardial cushion defect, hypoplastic left heart syndrome, pulmonic stenosis, coarctation of the aorta, and atrial and VSDs. A retrospective study of racial frequencies in 3 congenital heart malformations of children born in Baltimore hospitals in the 1960’s demonstrated no significant differences between black and white infants in the presence of transposition of the great vessels, coarctation of the aorta, and aortic atresia with left heart hypoplasia. An evaluation of congenital cardiac malformations by race and sex was evaluated in infants born in Louisiana in 1988–1989. Variability included a significantly higher prevalence of atrioventricular canal defects per 1000 live births in black women (0.74) compared with white women (0.41) and black men (0.20) and white men (0.12). On the other hand, aortic stenosis and ⁄or aortic coarctation were highest in white men. Single ventricle was higher in whites than blacks. Complete transposition of the great arteries was highest in white men (0.560 compared with black men (0.20) and black women (0.17) and white women (0.12). These differences further demonstrated the variability of certain congenital cardiac defects by race and sex. From the Rush University Medical Center, Chicago, IL Address for correspondence: Philip R. Liebson, MD, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 E-mail: pliebson@rush.edu Manuscript received May 15, 2009; accepted May 20, 2009