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

Emmanuel Akintoye, Karim Mahmoud, Mohamed Shokr, Aubin Sandio, Sagar Mallikethi-Reddy, Muhammad Sheikh, Oluwole Adegbala, Alexander Egbe, Alexandros Briasoulis, Luis Afonso

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalClinical Cardiology
Volume41
Issue number4
DOIs
StatePublished - Apr 1 2018

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Left Ventricular Hypertrophy
Cardiovascular Diseases
Hispanic Americans
Proportional Hazards Models
Ethnic Groups
Atherosclerosis
Databases

Keywords

  • Cardiovascular Events
  • Left Ventricular Mass
  • Mortality
  • Race/Ethnicity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Akintoye, E., Mahmoud, K., Shokr, M., Sandio, A., Mallikethi-Reddy, S., Sheikh, M., ... Afonso, L. (2018). Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease. Clinical Cardiology, 41(4), 502-509. https://doi.org/10.1002/clc.22914

Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease. / Akintoye, Emmanuel; Mahmoud, Karim; Shokr, Mohamed; Sandio, Aubin; Mallikethi-Reddy, Sagar; Sheikh, Muhammad; Adegbala, Oluwole; Egbe, Alexander; Briasoulis, Alexandros; Afonso, Luis.

In: Clinical Cardiology, Vol. 41, No. 4, 01.04.2018, p. 502-509.

Research output: Contribution to journalArticle

Akintoye, E, Mahmoud, K, Shokr, M, Sandio, A, Mallikethi-Reddy, S, Sheikh, M, Adegbala, O, Egbe, A, Briasoulis, A & Afonso, L 2018, 'Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease', Clinical Cardiology, vol. 41, no. 4, pp. 502-509. https://doi.org/10.1002/clc.22914
Akintoye, Emmanuel ; Mahmoud, Karim ; Shokr, Mohamed ; Sandio, Aubin ; Mallikethi-Reddy, Sagar ; Sheikh, Muhammad ; Adegbala, Oluwole ; Egbe, Alexander ; Briasoulis, Alexandros ; Afonso, Luis. / Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease. In: Clinical Cardiology. 2018 ; Vol. 41, No. 4. pp. 502-509.
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abstract = "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.",
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T1 - Racial/ethnic differences in the prognostic utility of left ventricular mass index for incident cardiovascular disease

AU - Akintoye, Emmanuel

AU - Mahmoud, Karim

AU - Shokr, Mohamed

AU - Sandio, Aubin

AU - Mallikethi-Reddy, Sagar

AU - Sheikh, Muhammad

AU - Adegbala, Oluwole

AU - Egbe, Alexander

AU - Briasoulis, Alexandros

AU - Afonso, Luis

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N2 - 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.

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KW - Cardiovascular Events

KW - Left Ventricular Mass

KW - Mortality

KW - Race/Ethnicity

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