Brown D W, Giles W H, Croft J B
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Am Heart J. 2000 Dec;140(6):848-56. doi: 10.1067/mhj.2000.111112.
Although associations between hypertension, left ventricular hypertrophy (LVH), and coronary heart disease (CHD) have been described, it is less clear whether LVH is associated with increased rates of CHD in the absence of hypertension.
We examined this association with Cox regression analyses of data from 7924 adults 25 to 74 years of age from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study (1976 to 1992). Covariates included age, race, sex, history of cardiovascular diseases and diabetes, cholesterol, body mass index, blood pressure, and smoking.
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-9 390-398, 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 among hypertensive adults than among normotensive adults (29.9 vs 6.4 per 1000, 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 (relative risk, 1.9; 95% confidence interval, 1.1, 3.0) after adjustment for hypertension and covariates. In age-adjusted predicted survival, probability plots for CHD, and diseases of the heart, normotensives with LVH had survival similar to hypertensive adults with LVH and lower survival than normotensive and hypertensive adults with no LVH.
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 individuals may have an increased risk for death similar to that of hypertensive adults with LVH.
尽管已有研究描述了高血压、左心室肥厚（LVH）与冠心病（CHD）之间的关联，但在无高血压的情况下，LVH是否与CHD发病率升高相关尚不清楚。
我们通过对第二次全国健康与营养检查调查（NHANES II）死亡率研究（1976年至1992年）中7924名年龄在25至74岁的成年人的数据进行Cox回归分析来研究这种关联。协变量包括年龄、种族、性别、心血管疾病和糖尿病病史、胆固醇、体重指数、血压和吸烟情况。
在16.8年的随访期间，有462例（26%）死于CHD（国际疾病分类第九版[ICD-9]编码410 - 414），667例（38%）死于心脏疾病（ICD-9编码390 - 398、402、404、410 - 414、415 - 417、420 - 429）。LVH患病率为每1000人中有13.3例。高血压患病率为29.1%。高血压成年人中的LVH患病率高于血压正常的成年人（每1000人分别为29.9例和6.4例，P <.001）。在对高血压和协变量进行调整后，患有LVH的人死于CHD的可能性是正常人的两倍（相对风险为2.0；95%置信区间为1.2至3.5），死于心脏疾病的可能性也是正常人的两倍（相对风险为1.9；95%置信区间为1.1至3.0）。在年龄调整后的预测生存率、CHD和心脏疾病的概率图中，血压正常但患有LVH的人的生存率与高血压且患有LVH的成年人相似，且低于无LVH的血压正常和高血压成年人。
我们的结果证实了先前的发现，即LVH的存在是未来心血管死亡的有力预测指标。尽管在血压正常的人群中LVH似乎很少见，但临床医生应意识到这类个体的死亡风险可能会增加，与患有LVH的高血压成年人相似。
