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A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: the Strong
R B Devereux1, M J Roman, M Paranicas
1Department of Medicine, Cornell Medical Center, New York, NY, USA.
Insights
Left ventricular dysfunction (LVD) affects about 14% of adults and is linked to heart failure and coronary heart disease. Risk factors include male sex, hypertension, overweight, arterial stiffening, and kidney problems.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Clinical congestive heart failure (CHF) is common, but population-based data on underlying left ventricular systolic dysfunction (LVD) are scarce.
- Understanding LVD prevalence and correlates is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence and identify correlates of left ventricular systolic dysfunction (LVD) in a population-based sample of American Indians.
- To investigate the association between LVD and clinical outcomes such as overt CHF and coronary heart disease.
Main Methods:
- Echocardiography was used in the Strong Heart Study (SHS) to assess left ventricular ejection fraction (LVEF) in 3184 American Indian participants.
- Mild LVD was defined as LVEF 40%-54%, and severe LVD as LVEF <40%.
Main Results:
- Mild and severe LVD were more prevalent in men and diabetic participants.
- LVD prevalence increased with age and was associated with higher rates of overt CHF and coronary heart disease.
- Lower LVEF was independently associated with CHF, coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal dysfunction.
Conclusions:
- Approximately 14% of middle-aged to elderly adults exhibit LVD.
- LVD is independently associated with overt heart failure, coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal target organ damage.
- Older age and diabetes were less consistently associated with LVD.
Background:
Although clinical congestive heart failure (CHF) is increasingly common, few data document the prevalence and correlates of underlying left ventricular (LV) systolic dysfunction (D) in population-based samples.
Methods:
Echocardiography was used in the second Strong Heart Study (SHS) examination to identify mild and severe LVD (LV ejection fraction [EF] 40%-54% and <40%, respectively) in 3184 American Indians.
Results:
Mild and severe LVD were more common in men than women (17.4% vs 7.2% and 4.7% vs 1.8%) and in diabetic than nondiabetic participants (12.7% vs 9.1% and 3.5% vs 1.6%). Stepwise increases were observed from participants with normal EF to those with mild and severe LVD in age (mean 60 vs 61 and 63 years, P <.001), prevalence of overt CHF (2% vs 6% and 28%) and definite coronary heart disease (3% vs 11% and 32%), systolic pressure (129 vs 135 and 136 mm Hg), serum creatinine level (0.98 vs 1.34 and 2.16 mg/dL), and log urinary albumin/creatinine level (3.2 vs 3.7 and 4.7); a negative relation was seen with body mass index (31.1 vs 31.0 and 28.4 kg/m(2)) (all P <.001). In multivariate analyses lower LVEFs were independently associated with clinical CHF and coronary heart disease, lower myocardial contractility, male sex, hypertension, overweight, arterial stiffening (higher pulse pressure/stroke volume) and renal dysfunction (higher serum creatinine level), higher LV mass, and lower relative wall thickness.
Conclusions:
LVD, present in approximately 14% of middle-aged to elderly adults, is independently associated with overt heart failure and coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal target organ damage and, less consistently, with older age and diabetes.
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