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Left ventricular hypertrophy has a greater impact on survival in women than in men
Y Liao1, R S Cooper, G A Mensah
1Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Ill 60153, USA.
Insights
Left ventricular hypertrophy (LVH) significantly increases mortality risk, with women experiencing a disproportionately higher risk compared to men. This sex difference in LVH impact is evident even without coronary artery disease.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) is linked to increased cardiovascular morbidity and mortality.
- Previous research has not systematically investigated potential sex differences in the mortality impact of LVH.
Purpose of the Study:
- To determine if there is a sex-specific difference in the association between left ventricular hypertrophy and mortality.
- To explore the impact of LVH on mortality in a cohort free of coronary artery disease.
Main Methods:
- A cohort of 436 Black patients without coronary artery disease was followed for a mean of 5 years.
- Left ventricular hypertrophy was defined using echocardiography and indexed to body surface area.
- Cox regression analysis was used to assess the risk of total and cardiac death associated with LVH, adjusting for relevant covariates.
Main Results:
- LVH was present in 52% of men and 44% of women.
- Patients with LVH had higher mortality rates than those without LVH.
- Adjusted analyses revealed a significantly greater relative risk of total death (RR=14.3) and cardiac death (RR=7.5) associated with LVH in women compared to men (RR=2.0 for total death).
Conclusions:
- A significant sex difference exists in the contribution of left ventricular hypertrophy to mortality.
- LVH poses a greater mortality risk for women than for men, independent of coronary artery disease.
Background:
Echocardiographically determined left ventricular hypertrophy (LVH) has a well-demonstrated association with cardiovascular morbidity and mortality. However, whether or not there is a sex differential in the impact of LVH on mortality has never been systematically explored.
Methods And Results:
This study enrolled 436 consecutive black patients (163 men and 273 women) free of angiographic coronary artery disease from a hospital registry. LVH (left ventricular [LV] mass/body surface area > or = 117 g/m2 in men and > or = 104 g/m2 in women) was present in 84 men (52%) and 119 women (44%). During a mean of 5 years' follow-up (range, 0 to 9), 49 patients (26 men and 23 women) died. The mortality rate was 5.40 per 100 patient-years in men with LVH and 2.58 in men without LVH (crude relative risk [RR] = 2.09) and 3.21 and 0.66, respectively, in women (RR = 4.87). In Cox regression analysis, adjusting for age, hypertension, and ejection fraction, the RR of total death for LVH versus non-LVH was 2.0 (95% confidence interval [CI], 0.8 to 5.0) in men and 14.3 (95% CI, 1.6 to 11.7) in women. For cardiac death, RR was 1.3 (95% CI, 0.4 to 3.7) and 7.5 (95% CI, 1.6 to 33.8) in men and women, respectively. Analyses using LV mass indexed by height or height with the use of different LVH cut points, comparing patients in the highest sex-specific tertile of mass index to those in the lower two tertiles, and the use of LV mass indexes as continuous variables similarly demonstrated a greater increase in risk of either fatal end point among women than men.
Conclusions:
These findings indicate a sex difference in the contribution of LV mass and hypertrophy to mortality in the absence of coronary artery disease.