Cardiac Comorbidities Plague Chagas Disease Patients

NATIONAL HARBOR, Md. -- Many patients with Trypanosoma cruzi infection, or Chagas disease, in Los Angeles had multiple other comorbidities, a researcher said here.

In a multivariable analysis, both cardiomyopathy and age were significant predictors of multiple comorbidities in these patients, reported Salvador Hernandez, MD, of the Centers of Excellence for Chagas Disease in Sylmar, California.

More than half of patients with Chagas disease had two or more comorbidities, he noted at a presentation at the American Society of Tropical Medicine & Hygiene annual meeting.

Although Chagas disease is often thought of as a parasitic infection that predominantly affects rural areas of Latin America, Hernandez noted a large epidemiological burden of cases in the U.S., including an estimated 70,000 in California, 37,000 in Texas, 18,000 in Florida, and 17,000 in New York, none of which included undocumented individuals. However, he added that Chagas disease is severely underdiagnosed in the U.S., with less than 1% of cases diagnosed and only 1%-2% of cases treated.

Hernandez said that of patients who are infected with Chagas disease, 30%-40% will progress to the chronic phase of the disease, which does not present until 20-30 years after the initial infection. Of these cases, 60%-70% will have cardiac involvement. This starts as abnormalities on EKG, such as a right bundle branch block or a left anterior fascicular block. These symptoms are followed by slow progressive cardiomyopathy until symptoms of heart failure and sudden death from arrhythmia.

"At this final stage, the disease becomes irreversible and treatment with anti-parasitic therapy does not alter the disease course," Hernandez noted.

Prior research from the Centers of Excellence for Chagas Disease found a wide ranging of prevalence of the infection in Los Angeles, with the highest prevalence in Latin American-born patients with non-ischemic cardiomyopathy, Latin American-born patients with pacemakers, and Latin American-born patients with ECG abnormalities.

They performed a retrospective chart review of 221 patients from their center, who were a mean age of about 56, and had been in the U.S. for an average of 37 years. More than half of the patients were women, about half were from El Salvador, with about a quarter from Mexico, and a little less than half were ages 50-69. A little over 30% of these patients had cardiomyopathy.

The most common comorbidity among these patients was hypertension (43%), followed by obesity (39.6%) and hyperlipidemia (30.6%). Only 30% of patients had no comorbidities, while 9% had five or more in this cohort.

Men had a significantly higher number of comorbidities compared with women (2.22 vs 1.63, respectively), and the same was observed for patients with cardiomyopathy versus patients with no cardiomyopathy (3.06 vs 1.34). Hernandez also noted that comorbidities increased with age, with patients ages 70 and older having a mean of almost three comorbidities compared to younger patients ages 18-39 with less than one.

Hernandez noted that Chagas disease has 30,000 new cases annually worldwide, but is severely underdiagnosed in the U.S. and is predominantly seen in a population without access to healthcare. He noted that among the patients in the Center of Excellence for Chagas Disease, about 63% are living below the federal poverty level, 66% have less than a high school education, and 72% rely on public insurance in California.

"Care for Chagas disease should ideally be integrated into the primary care setting, so that when you check for hypertension or diabetes, you can properly screen and treat these patients," he said.