CLINICAL STUDY: RACE, GENDER, AND CAD
The influence of left ventricular hypertrophyon survival in patients with coronaryartery disease: do race and gender matter?
Mark A. East, MD*,*,
James G. Jollis, MD, FACC*,
Charlotte L. Nelson, MS*,
David Marks, MD, FACC and
Eric D. Peterson, MD, MPH, FACC*
* Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina, USA
Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Manuscript received September 10, 2001;
revised manuscript received April 17, 2002,
accepted October 25, 2002.
* Reprint requests and correspondence: Dr. Mark A. East, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715, USA.
east0001{at}onyx.dcri.duke.edu
OBJECTIVES: We sought to determine the overall prognostic importance of left ventricular hypertrophy (LVH) among patients with coronary artery disease (CAD), as well as to determine whether this risk varies as a function of race or gender.
BACKGROUND: Left ventricular hypertrophy is more prevalent among blacks and women than their counterparts. Blacks and women also have higher mortality with coronary disease.
METHODS: We studied records of 2,461 patients (19% black, 42% women) diagnosed with CAD at cardiac catheterization between 1990 and 1998 from a single academic center. Left ventricular hypertrophy was defined using standard echocardiographic measures. Cox proportional hazards models were used for adjusted survival analyses. Mean patient follow-up was three years.
RESULTS: Patients with LVH were older (68 vs. 65 years, p < 0.01), more often women (54% vs. 36%, p < 0.01), and black (25% vs. 16%, p < 0.01), and had higher unadjusted three-year mortality rates than patients without LVH (42% vs. 34%, p < 0.01). Left ventricular hypertrophy remained an independent predictor of mortality after adjusting for other clinical risk factors (hazard ratio 1.56, 95% confidence interval 1.35 to 1.80) with prognostic importance equivalent to that of left ventricular ejection fraction. Although the relative risk of LVH did not vary by race or gender, the attributable risk of LVH was greater in blacks and women.
CONCLUSIONS: Clinicians should consider the prognostic importance of LVH when assessing risk in patients with CAD. Because LVH is more common among black and women patients with CAD, it partially accounts for racial and gender differences in survival.
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Abbreviations and Acronyms
| | BSA | | body surface area | | CAD | | coronary artery disease | | CI | | confidence interval | | HR | | hazard ratio | | IVSTd | | interventricular septal thickness at end-diastole | | LV | | left ventricular | | LVH | | left ventricular hypertrophy | | LVIDd | | left ventricular internal dimension at end-diastole | | LVM | | left ventricular mass | | LVMI | | left ventricular mass index | | PAR | | population attributable risk | | PWTd | | posterior wall thickness at end-diastole | | RR | | relative risk |
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