Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension

Background Although associations between hypertension, left ventricular hyp ertrophy (LVH), and coronary heart disease (CHD) have been described, it is less clear whether LVH is associated with increased rates of CHD in the ab sence of hypertension. Methods we examined this association with Cox regression analyses of data f rom 7924 adults 25 to 74 years of age from the Second National Health and N utrition Examination Survey (NHANES II) Mortality Study (1976 to 1992). Cov ariates included age, race, sex, history of cardiovascular diseases and dia betes, cholesterol, body moss index, blood pressure, and smoking. Results During 16.8 follow-up years, there were 462 (26%) deaths from CHD ( ICD-9 410-414) and 667 (38%) deaths from diseases of the heart (ICD-9 390-3 98, 402, 404, 410-414, 415-417, 420-429). LVH prevalence was 13.3 per 1000 population. Hypertension prevalence was 29.1%. LVH prevalence was higher am ong hypertensive adults than among normotensive adults (29.9 vs 6.4 per 100 0, P <.001). Persons with LVH were twice as likely to die of CHD (relative risk, 2.0; 95% confidence interval, 1.2, 3.5) and diseases of the heart (re lative risk, 1.9, 95% confidence interval, 1.1, 3.0) after adjustment for h ypertension and covariates. In age-adjusted predicted survivor, probability plots for CHD, and diseases of the heart, normotensives with LVH had survi val similar to hypertensive adults with LVH and lower survival than normote nsive and hypertensive adults with no LVH. Conclusions our results confirm previous findings that the presence of LVH is a strong predictor of future cardiovascular death. Although LVH appears to be rare among normotensives clinicians should be aware that such individ uals may have on increased risk for death similar to that of hypertensive a dults with LVH.