Abstract 11976: Left ventricular Mass in Young Healthy Adults Predicts 20-year Clinical Cardiovascular Events Beyond the Global Cardiovascular Framingham 10 Year Risk Score: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

OBJECTIVE The incremental value of left ventricular mass (LVM) over Framingham risk score (FRS) predicting cardiovascular events (CVE) is unclear, especially in young adulthood. We assessed the predictive ability of FRS for CVE in a large young cohort and investigated whether adding information about LVM and indices (LVMi) would improve this performance.

METHODS The CARDIA study enrolled African-American and White adults from 4 US centers in 1985-1986. Five years later (baseline), LVM was assessed by M-mode echocardiography and indexed to body surface area (BSA), height^1.7, or height^2.7. Participants were divided in low, intermediate, and high risk groups for FRS <2.5%, 2.5-15%, and >15%, respectively. 118 participants had CVE (cardiovascular death; or nonfatal heart failure, myocardial infarction, stroke, transient ischemic attack, and peripheral artery disease) in the following 20 years (3% of the 3980 participants included). We assessed calibration and discrimination for adding LVM to FRS. Also stratified and global net reclassification improvements (NRI) were computed.

RESULTS Participants were aged 30±4 years at baseline, 46% males, 52% White. Event incidence across FRS low, intermediate, and high risk was respectively 1.3%, 5.4%, and 23.1% (p<0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% (p<0.001) across quartiles of LVM (cut-points 117g, 144g, and 176g), with similar results for each LVMi. Adjusted for FRS, hazard ratios predicting CVE events for LVM and LVMi ranged over 1.21- 1.25 for 1 SD increase, all p<0.001). Adding either LVM or LVMi significantly increased discrimination compared to FRS alone. The NRI by adding LVM or LVMi to the risk prediction was positive and significant for those at low and intermediate risk (Table).

CONCLUSION FRS and LVM are independent predictors of CVE in these young adults. Addition of LVM or LVMi improves prediction of CVE, discrimination, and effectively reclassifies participants beyond FRS alone.