Abstract 12275: Competing Cardiovascular Outcomes Associated with Electrocardiographic Left Ventricular Hypertrophy: The Atherosclerosis Risk in Communities Study
Background: Individuals with electrocardiographically-determined left ventricular hypertrophy (ECG LVH) are at risk for multiple cardiovascular disease (CVD) outcomes simultaneously. We sought to determine risk for CVD events in individuals with ECG LVH in a competing risk framework, in order to characterize the type of first CVD events in these individuals compared with those without ECG LVH.
Methods: We included participants (ppts) in the Atherosclerosis Risk in Communities (ARIC) study, from the NHLBI limited-access dataset. ECG LVH was defined according to the Sokolow-Lyon criteria. We used competing Cox models to compare hazards for diverse outcomes within groups (e.g., among those with ECG LVH) and to compare hazards for a given event between groups (ECG LVH versus no ECG LVH).
Results: Of 15,527 ppts (55% women; 27% black; mean age 54y), 4.9% had ECG LVH at baseline. Over 15 years of follow up, ppts with and without ECG LVH had similar rates of non-CVD death (see Table). Men with and without ECG LVH had hazards ratio for CVD events compared with non-CVD death occurring first of 4.86 (95% CI, 3.04-7.77) and 2.67 (95% CI, 2.39-2.98), respectively. Similar results were observed in women. Among those with ECG LVH, the most common first events were coronary heart disease (CHD) in men (15.0%) and heart failure (HF) in women (10.5%). Men and women with ECG LVH were at significantly higher risk for all CVD events and each subtype (except other CVD death) compared with ppts without ECG LVH; men were 1.4 to 2 times and women were 2.5 to 2.8 times more likely to have a CVD event first compared to those without ECG LVH. After adjustment for demographics and CVD risk factors including systolic blood pressure, any CVD event remained 1.5 times more likely to occur first in those with ECG LVH compared to those without.
Conclusions: Individuals with ECG LVH are more likely to have a CVD event occur before non-CVD death over 15 years of follow up. The most likely first events are CHD in men and HF in women.
- © 2011 by American Heart Association, Inc.