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Four common risk factors for MI linked with increased LV mass
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Smoking, high systolic BP, diabetes and adiposity increase left ventricular mass over a lifetime.
Researchers examined longitudinal data collected from 4,217 (53% women) participants in the Framingham Heart Study. The researchers evaluated the patients with routine transthoracic ECG, and tracked both short- and long-term LV mass.
According to the analysis, age, sex, BMI, systolic BP, antihypertensive treatment, smoking and diabetes were fundamental determinants in tracking LV mass over the 16-year observational period. There was an interaction between age and sex (P<.0001), with women having a greater risk for increased LV mass compared with men. The researchers reported an association between diabetes and LV mass (P=.0016) and an interaction between age and diabetes (P=.0003). Sex, BMI, systolic BP, antihypertensive treatment, smoking and the interaction between age and diabetes were associated with short-term, four-year change in LV mass. The cumulative burden of other CV risk factors was also associated with increased LV mass over time.
The researchers reported that 30-year estimates derived from extrapolated data from the 10-year risk estimates were inadequate to predict long-term risk.
“Given the increasing burden of HF in the United States, it is important to understand the determinants of cardiac remodeling over the adult life course,” the researchers concluded. “These findings are consistent with the notion that maintenance of optimal levels of these risk factors in midlife will reduce the burden of subclinical LV hypertrophy, and presumably HF, in older age.”
Lieb W. Circulation. 2009;doi:10.1161/CIRCULATIONAHA.108.824243.
This study identifies the contributors to left ventricular hypertrophy (LVH), and identifies many others than hypertension. Risk factor modification (implementation of existing guidelines) would be expected to prevent LVH. Cardiologists should consider routinely measuring LV mass in grams in at-risk patients getting ECGs, and follow it in a manner similar to BP, blood cholesterol and blood sugar. Automated integral ECG software can do this, and laboratory variability can be acceptable with staff and physician training.
The sex difference noted whereby women progress their LV mass relatively more rapidly than men provides mechanistic understanding as to the high prevalence of women with HF with preserved ejection fraction compared with men. Basic and human research suggests that women have less ventricular fibrosis with hypertrophy compared with men, contributing to a higher relative LV mass with less ventricular dilation in women.
– C. Noel Bairey Merz, MD
Cardiology Today Editorial Board member