Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2018-04, Vol.41 (4), p.502-509
• Main Authors: Akintoye, Emmanuel, Mahmoud, Karim, Shokr, Mohamed, Sandio, Aubin, Mallikethi‐Reddy, Sagar, Sheikh, Muhammad, Adegbala, Oluwole, Egbe, Alexander, Briasoulis, Alexandros, Afonso, Luis
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Asian Americans; Cardiovascular disease; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cardiovascular Events; Clinical Investigations; Comorbidity; Continental Population Groups; Cultural differences; Databases, Factual; Disease Progression; European Continental Ancestry Group; Female; Hispanic Americans; Hispanic people; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - ethnology; Hypertrophy, Left Ventricular - mortality; Hypertrophy, Left Ventricular - physiopathology; Incidence; Left Ventricular Mass; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mortality; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Race/Ethnicity; Risk Factors; Time Factors; United States - epidemiology; Ventricular Function, Left; Ventricular Remodeling
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22914

Background Evidence exists for racial/ethnic differences in left ventricular mass index (LVMI). How this translates to future cardiovascular disease (CVD) events is unknown. Hypothesis The impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes could have potential implications for the optimization of risk stratification strategies. Methods Using the prospectively collected database of the Multi‐Ethnic Study of Atherosclerosis (MESA) involving 4 racial/ethnic groups (non‐Hispanic Whites, Chinese, Blacks, and Hispanics) free of CVD at baseline, we assessed for racial/ethnic differences in the relationship between LVMI and incident CVD using a Cox model. Results 5004 participants (mean age, 62 ± 10 years; 48% male) were included in this study. After an average follow‐up of 10.2 years, 369 (7.4%) CVD events occurred. Significant racial/ethnic differences existed in the relationship between LVMI and incident CVD (P for interaction = 0.04). Notably, the relationship was strongest for Chinese (HR per 10‐unit increase in LVMI: 1.7, 95% CI: 1.1–2.8) and Hispanics (HR per 10‐unit increase in LVMI: 1.9, 95% CI: 1.5–2.2). Non‐Hispanic Whites demonstrated the lowest relationship (HR: 1.3, 95% CI: 1.1–1.5). LVMI values of 36.9 g/m2.7, 31.8 g/m2.7, 39.9 g/m2.7, and 41.7 g/m2.7 were identified as optimal cutpoints for defining left ventricular hypertrophy (LVH) for non‐Hispanic Whites, Chinese, Blacks, and Hispanics, respectively. In secondary analysis of LVH (vs no LVH) using these optimal cutpoints, we found a similar pattern of association as above (P for interaction = 0.04). For example, compared with those without LVH, Chinese with LVH had HR: 5.3, 95% CI: 1.6–17, whereas non‐Hispanic Whites with LVH had HR: 1.6, 95% CI: 1.2–2.1 for CVD events. Conclusions Among 4 races/ethnicities studied, LVMI has more prognostic utility predicting future CVD events for Chinese and Hispanics and is least significant for non‐Hispanic Whites.