A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: The Strong Heart Study

Background Although clinical congestive heart failure (CHF) is increasingly common, few data document the prevalence and correlates of underlying left ventricular (IV) systolic dysfunction (D) in population-based samples. Methods Echocardiography was used in the second Strong Heart Study (SHS) ex amination to identify mild and severe LVD (LV ejection fraction [EF] 40%-54 % and <40%, respectively) in 3184 American Indians. Results Mild and severe LVD were more common in men than women (17.4% vs 7. 2% and 4.7% vs 1.8%) and in diabetic than nondiabetic participants (12.7% v s 9.1% and 3.5% vs 1.6%). Stepwise increases were observed from participant s with normal EF to those with mild and severe LVD in age (mean 60 vs 61 an d 63 years, P<.001), prevalence of overt CHF (2% vs 6% and 28%) and definit e coronary heart disease (3% vs 11% and 32%), systolic pressure (129 vs 135 and 136 mm Hg), serum creatinine level (0.98 vs 1.34 and 2.16 mg/dL), and log urinary albumin/creatinine level (3.2 vs 3.7 and 4.7); a negative relat ion was seen with body moss index (31.1 vs 31.0 and 28.4 kg/m(2)) (all P<.0 01), In multivariate analyses lower LVEFs were independently associated wit h clinical CHF and coronary heart disease, lower myocardial contractility, male sex, hypertension, overweight, arterial stiffening (higher pulse press ure/stroke volume) and renal dysfunction (higher serum creatinine level), h igher LV mass, and lower relative wall thickness. Conclusions LVD, present in approximately 14% of middle-aged to elderly adu lts, is independently associated with overt heart failure and coronary hear t disease, male sex, hypertension, overweight, arterial stiffening, and ren al target organ damage and, less consistently, with older age and diabetes.