LEFT-VENTRICULAR MASS AND RISK OF STROKE IN AN ELDERLY COHORT - THE FRAMINGHAM HEART-STUDY

Objective.-To evaluate the association of echocardiographically determ ined left ventricular mass (LVM) with incidence of stroke or transient ischemic attack in an elderly cohort. Design.-Cohort study with a fol low-up period of 8 years. Setting.-Population-based sample. Subjects.- Elderly original cohort subjects of the Framingham Heart Study who wer e free of cerebrovascular disease and atrial fibrillation at the 16th biennial examination and who had adequate echocardiograms. This group consisted of 447 men (mean age, 67.8 years; range, 60 to 90 years) and 783 women (mean age, 69.2 years; range 59 to 90 years). Main Outcome Measures.-Age-adjusted 8 year incidence of stroke was examined as a fu nction of baseline quartiles of LVM-to-height ratio. Proportional haza rds regression was used in multivariate analyses to assess risk of str oke as a function of LVM-to-height ratio quartile, adjusting for age, sex, systolic blood pressure, hypertension treatment, diabetes, cigare tte smoking, and blood lipid levels. Results.-Among the 1230 subjects eligible, 89 cerebrovascular disease events (62 strokes and 27 transie nt ischemic attacks) occurred during follow-up. In men, 8-year age-adj usted incidence of cerebrovascular events was 18.4% in the highest qua rtile of LVM-to-height ratio and 5.2% in the lowest quartile. Correspo nding values in women were 12.2% and 2.9%. The hazard ratio for cerebr ovascular events comparing highest to lowest quartile of LVM-to-height ratio was 2.72 (95% confidence interval [CI], 1.39 to 5.36) after adj usting for age, sex, systolic blood pressure, hypertension treatment, diabetes, cigarette smoking, and the ratio of total cholesterol to hig h-density lipoprotein cholesterol. After adjusting for age, sex, and c ardiovascular disease risk factors, the hazard ratio for cerebrovascul ar events was 1.45 (95% CI, 1.17 to 1.80) for each quartile increment of LVM-to-height ratio. Conclusions.-Echocardiographically determined LVM-to-height ratio offers prognostic information beyond that provided by traditional cerebrovascular disease risk factors. Echocardiography provides information that facilitates identification of individuals a t high risk for stroke and transient ischemic attack.