Abstract 5533: Gender Differences in Outcome During Antihypertensive Therapy in Relation to Regression of Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study
Background: Men and women have well-established differences in the magnitude of ECG amplitudes and durations and women have less regression of ECG left ventricular hypertrophy (LVH) in response to blood pressure lowering, even after adjusting for gender differences in baseline severity of LVH, treatment effects and blood pressure changes. However, whether women experience less prognostic benefit from their lesser regression of ECG LVH has not been examined.
Methods and Results: Cardiovascular (CV) outcomes were examined in relation to regression of Sokolow-Lyon voltage (SLV) in 4963 women and 4230 men randomly assigned to losartan- or atenolol-based treatment. ECGs were performed at baseline, 6 months and then yearly until study end. Regression of LVH was dichotomized using sex-specific median decreases in SLV ≥3.0 mm in women and ≥4.5 mm in men. Women had significantly lower 5-year event rates for CV death (3.8 vs 6.2%, p<0.0001), MI (3.3 vs 6.0%, p<0.0001), stroke (5.5 vs 7.3%, p=0.003) and the LIFE study composite endpoint of these three events (9.8 vs 15.6%, p<0.0001). In Cox regression analyses performed separately in women and men, women and men had similar reductions in risk of all events associated with regression of SLV defined by decreases in SLV exceeding the sex-specific median entered as time-varying covariates (Table⇓). The absence of gender differences in predictive value of regression of SLV LVH was confirmed by the absence of any significant interaction term between gender and change in SLV, with analyses performed treating SLV as either a sex-specific median decrease or as a continuous variable with no adjustment for gender.
Conclusions: Despite lesser regression of ECG LVH than men, women have lower event rates than men and appear to derive the same degree of risk reduction as men from greater regression of SLV, independent of treatment effects, in-treatment blood pressure and the impact of possible gender differences in other risk factors on outcomes.