LEFT-VENTRICULAR HYPERTROPHY HAS A GREATER IMPACT ON SURVIVAL IN WOMEN THAN IN MEN

Background Echocardiographically determined left ventricular hypertrop hy (LVH) has a well-demonstrated association with cardiovascular morbi dity and mortality. However, whether or not there is a sex differentia l in the impact of LVH on mortality has never been systematically expl ored. Methods and Results This study enrolled 436 consecutive black pa tients (163 men and 273 women) free of angiographic coronary artery di sease from a hospital registry. LVH (left ventricular [LV] mass/body s urface area greater than or equal to 117 g/m(2) in men and greater tha n or equal to 104 g/m(2) in women) was present in 84 men (52%) and 119 women (44%). During a mean of 5 years' follow-up (range, 0 to 9), 49 patients (26 men and 23 women) died. The mortality rate was 5.40 per 1 00 patient-years in men with LVH and 2.58 in men without LVH (crude re lative risk [RR]=2.09) and 3.21 and 0.66, respectively, in women (RR-4 .87). In Cox regression analysis, adjusting for age, hypertension, and ejection fraction, the RR of total death for LVH versus non-LVH was 2 .0 (95% confidence interval [CI], 0.8 to 5.0) in men and 4.3 (95% CI, 1.6 to 11.7) in women. For cardiac death, RR was 1.3 (95% CI, 0.4 to 3 .7) and 7.5 (95% CI, 1.6 to 33.8) in men and women, respectively. Anal yses using LV mass indexed by height or height(27) with the use of dif ferent LVH cut points, comparing patients in the highest sex-specific tertile of mass index to those in the lower two tertiles, and the use of LV mass indexes as continuous variables similarly demonstrated a gr eater increase in risk of either fatal end point among women than men. Conclusions These findings indicate a sex difference in the contribut ion of LV mass and hypertrophy to mortality in the absence of coronary artery disease.