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Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular
Emmanuel Akintoye1, Karim Mahmoud1, Mohamed Shokr1
1Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Insights
Left ventricular mass index (LVMI) predicts cardiovascular disease (CVD) events differently across racial/ethnic groups. This prognostic utility is strongest for Chinese and Hispanic individuals, and least significant for non-Hispanic Whites.
Area of Science:
- Cardiology
- Epidemiology
- Genetics
Background:
- Racial and ethnic variations in left ventricular mass index (LVMI) are documented.
- The association between LVMI and future cardiovascular disease (CVD) risk across different racial/ethnic groups remains unclear.
Purpose of the Study:
- To investigate the impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes.
- To evaluate the potential implications for optimizing CVD risk stratification strategies.
Main Methods:
- Utilized the Multi-Ethnic Study of Atherosclerosis (MESA) database, including 4 racial/ethnic groups.
- Assessed racial/ethnic differences in the relationship between LVMI and incident CVD using Cox models.
- Followed 5004 participants free of CVD at baseline for an average of 10.2 years.
Main Results:
- Significant racial/ethnic differences were observed in the LVMI-CVD event relationship (P for interaction = 0.04).
- The association was strongest for Chinese and Hispanic individuals, and weakest for non-Hispanic Whites.
- Optimal LVMI cutpoints for left ventricular hypertrophy (LVH) varied by race/ethnicity, with LVH conferring higher CVD risk in Chinese and Hispanic individuals compared to non-Hispanic Whites.
Conclusions:
- LVMI demonstrates varying prognostic utility for predicting future CVD events across diverse racial/ethnic populations.
- The predictive value of LVMI for CVD events is greater in Chinese and Hispanic populations compared to non-Hispanic Whites.
Background:
Evidence exists for racial/ethnic differences in left ventricular mass index (LVMI). How this translates to future cardiovascular disease (CVD) events is unknown.
Hypothesis:
The impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes could have potential implications for the optimization of risk stratification strategies.
Methods:
Using the prospectively collected database of the Multi-Ethnic Study of Atherosclerosis (MESA) involving 4 racial/ethnic groups (non-Hispanic Whites, Chinese, Blacks, and Hispanics) free of CVD at baseline, we assessed for racial/ethnic differences in the relationship between LVMI and incident CVD using a Cox model.
Results:
5004 participants (mean age, 62 ± 10 years; 48% male) were included in this study. After an average follow-up of 10.2 years, 369 (7.4%) CVD events occurred. Significant racial/ethnic differences existed in the relationship between LVMI and incident CVD (P for interaction = 0.04). Notably, the relationship was strongest for Chinese (HR per 10-unit increase in LVMI: 1.7, 95% CI: 1.1-2.8) and Hispanics (HR per 10-unit increase in LVMI: 1.9, 95% CI: 1.5-2.2). Non-Hispanic Whites demonstrated the lowest relationship (HR: 1.3, 95% CI: 1.1-1.5). LVMI values of 36.9 g/m2.7 , 31.8 g/m2.7 , 39.9 g/m2.7 , and 41.7 g/m2.7 were identified as optimal cutpoints for defining left ventricular hypertrophy (LVH) for non-Hispanic Whites, Chinese, Blacks, and Hispanics, respectively. In secondary analysis of LVH (vs no LVH) using these optimal cutpoints, we found a similar pattern of association as above (P for interaction = 0.04). For example, compared with those without LVH, Chinese with LVH had HR: 5.3, 95% CI: 1.6-17, whereas non-Hispanic Whites with LVH had HR: 1.6, 95% CI: 1.2-2.1 for CVD events.
Conclusions:
Among 4 races/ethnicities studied, LVMI has more prognostic utility predicting future CVD events for Chinese and Hispanics and is least significant for non-Hispanic Whites.
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