Left Ventricular Hypertrophy and Incidence of Acute Coronary Heart Disease and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS)
Ronald J. Prineas *
Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
Anh Le
Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
Stephen P. Glasser
Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Vera Bittner
Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
William M. McClellan
Department of Epidemiology, Rollins School of Public health, Emory University, Atlanta, AL, USA
Xin Wang
Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Yulia Khodneva
Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Monika M. Safford
Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
*Author to whom correspondence should be addressed.
Abstract
Objective: To examine the relationship between left ventricular hypertrophy (LVH) and the incidence of acute coronary heart disease (CHD) and mortality in the modern era.
Methods: We studied 16, 390 black and white participants free of clinical CHD from a US national sample. The independent prognostic value of ECG-LVH was determined by Cornell voltage (CV) for risk of incident acute CHD and total mortality overall and by race and sex.
Results: 410 incident acute CHD events and 993 deaths occurred over a median follow-up of 4.8 years. CV LVH was associated with outcomes: more common in blacks (4.1%) than whites (1.2%) and in women (3.9%) than men (1.3%). However, men with CV LVH (HR 2.12 [95% CI 1.02-4.42) had greater risk for incident acute CHD than women (HR 1.29 [95% CI 0.79-2.11]) after adjusting for demographic, behavioral and clinical variables. By contrast, CV LVH conferred similar hazards for incident acute CHD among blacks (HR 1.63 [1.00-2.68; p=0.050]) and whites (HR 1.58 [95% CI 0.76-3.28; p=0.22]). Mortality associated with CV LVH was elevated overall (HR 1.31 [95% CI 1.00-1.71]) and for blacks (HR 1.36 [95% CI 1.00-1.86]) but not whites (HR 1.16 [95% CI 0.70-1.94]), with similar risk for women (HR 1.24 [95% CI 0.92-1.67] and for men (HR 1.30 [95% CI 0.72-2.35]).
Conclusion: In this contemporary cohort, CV LVH was significantly prognostic for incident acute CHD for men but not women and there was no evidence of race differences. However, CV LVH was significantly prognostic for total mortality for blacks but not whites without evidence of sex differences.
Keywords: Left ventricular hypertrophy, myocardial infarction, mortality, racial disparities