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Inappropriate Left Ventricular Mass and Cardiovascular Disease Events and Mortality in Blacks: The Jackson Heart

D Edmund Anstey1, Rikki M Tanner2, John N Booth2

  • 1Columbia University Irving Medical Center New York NY.

Journal of the American Heart Association
|August 14, 2019
PubMed

Insights

Inappropriate left ventricular mass (iLVM) increases cardiovascular disease (CVD) risk, particularly in Black individuals without left ventricular hypertrophy (LVH). This finding highlights iLVM as a critical, yet often overlooked, CVD risk factor.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Left ventricular hypertrophy (LVH) is a known risk factor for cardiovascular disease (CVD) and mortality.
  • Inappropriate left ventricular mass (iLVM) describes a condition where left ventricular mass exceeds predicted levels, even without overt LVH.
  • The association between iLVM and adverse cardiovascular outcomes, particularly in specific populations like Black individuals, requires further investigation.

Purpose of the Study:

  • To investigate the association between inappropriate left ventricular mass (iLVM) and the risk of cardiovascular disease (CVD) events and all-cause mortality.
  • To examine these associations specifically within the Black population, utilizing data from the Jackson Heart Study.
  • To explore whether the presence of left ventricular hypertrophy (LVH) modifies the relationship between iLVM and adverse outcomes.

Main Methods:

  • Analysis of data from the Jackson Heart Study, a community-based cohort study of Black individuals.
  • Inclusion of 4424 participants without pre-existing CVD and with baseline echocardiogram data.
  • Assessment of iLVM prevalence and its association with CVD events and all-cause mortality over a median follow-up of 9.7 years, using multivariable adjustment and interaction analyses.

Main Results:

  • The prevalence of iLVM in the study cohort was 13.8%.
  • Participants with iLVM exhibited a higher rate of CVD events and all-cause mortality compared to those without iLVM.
  • After multivariable adjustment, iLVM was significantly associated with an increased risk of CVD events (HR, 1.87) and showed a trend towards increased all-cause mortality (HR, 1.29). Notably, iLVM conferred a significantly higher risk for CVD events in those without LVH (HR, 2.53) compared to those with LVH (HR, 1.21) (Pinteraction=0.029).

Conclusions:

  • Inappropriate left ventricular mass (iLVM) is a significant independent risk factor for cardiovascular events in the Black population.
  • iLVM is particularly associated with an elevated risk of CVD events among Black individuals who do not have overt left ventricular hypertrophy (LVH).
  • These findings underscore the importance of considering iLVM in cardiovascular risk assessment, especially in at-risk populations.

Keywords:
blackcardiovascular diseaseinappropriate left ventricular massleft ventricular hypertrophymortality

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