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Why is left ventricular hypertrophy so predictive of morbidity and mortality?
1National Heart, Lung, and Blood Institute's Framingham Heart Study, MA 01702, USA. emelia@fram.nhlbi.nih.gov
Insights
Left ventricular hypertrophy (LVH) affects 14-18% of adults and independently predicts cardiovascular events and mortality. Further research is needed to understand LVH
Area of Science:
- Cardiology
- Epidemiology
- Genetics
Background:
- Left ventricular hypertrophy (LVH) is a significant cardiovascular condition.
- Its prevalence, prognosis, and predictors are crucial for understanding heart disease.
- Existing research highlights controversies in LVH pathogenesis and its link to poor outcomes.
Purpose of the Study:
- To review the prevalence, prognosis, and predictors of left ventricular hypertrophy (LVH).
- To summarize theories on the pathogenesis of the LVH-poor prognosis relationship.
- To identify unanswered questions and guide future research, such as the Jackson Heart Study.
Main Methods:
- Review of existing literature on left ventricular hypertrophy (LVH).
- Analysis of data from the Framingham Heart Study (primarily white population).
- Comparison of LVH prevalence and outcomes across different racial groups, considering factors like hypertension and obesity.
Main Results:
- Echocardiographic LVH prevalence is 14% in men and 18% in women in the Framingham Heart Study.
- LVH prevalence may be higher in African Americans, potentially linked to hypertension and obesity.
- LVH is an independent predictor of cardiovascular endpoints (coronary heart disease, stroke) and doubles mortality risk in both white and African American cohorts.
Conclusions:
- LVH is a significant independent risk factor for cardiovascular disease and mortality.
- Many questions remain regarding the genetic contributions, prognosis in diverse populations, and relationship with risk factor treatment.
- The Jackson Heart Study is poised to address critical knowledge gaps in LVH research.
Abstract:
The prevalence, prognosis, and predictors of left ventricular hypertrophy (LVH) are reviewed, and theories of the pathogenesis of the relation between LVH and poor prognosis are summarized to highlight controversies in the field. In the Framingham Heart Study, which consists largely of white people, echocardiographic LVH has a prevalence of 14% in men and 18% in women. The prevalence of LVH is reported to be elevated in African Americans compared with whites, although the higher prevalence has been attributed to the increased prevalence of hypertension and obesity. Echocardiographic LVH is independently associated with a variety of cardiovascular endpoints, including coronary heart disease and stroke. Furthermore, after adjusting for other cardiovascular disease risk factors, LVH is associated with a doubling in mortality in both white and African American cohorts. Despite the intensive investigation of LVH, there remain many unanswered questions: To what extent do genetic or other factors account for the large portion of the variance in LVH that remains unexplained? What is the prognosis of LVH and left ventricular geometry in a population-based African American cohort? How does the development and progression of LVH relate to other risk factors and their treatment? What is the relation of LVH to poor prognosis? The proposed Jackson Heart Study will help address many important unanswered questions regarding LVH.