Nunez Eduardo, Arnett Donna K, Benjamin Emelia J, Oakes J Michael, Liebson Philip R, Skelton Thomas N
Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota 55454, USA.
Am J Cardiol. 2004 Dec 1;94(11):1383-90. doi: 10.1016/j.amjcard.2004.08.012.
Echocardiographically determined left ventricular (LV) hypertrophy may be a stronger risk factor of cardiovascular disease (CVD) for women than for men, although it is unclear whether reported gender differences are real or attributable to confounding. We evaluated echocardiographic LV hypertrophy (defined as LV mass/height(2.7) >/=51 g/m(2.7)) collected from the African-American population of the Atherosclerosis Risk in Communities Study. Incident CVD events (57 in men, 62 in women) were determined during a median follow-up of 4.9 years (interquartile range 4.3 to 5.6) and included nonfatal myocardial infarction, cardiac death, coronary revascularization, and stroke. We conducted 2 analyses. First, we created matched samples of 340 men and 812 women who had LV hypertrophy based on propensity score and estimated the gender-specific incidence rate ratios and population-attributable risks. Second, we evaluated the complete cohort (604 men and 1,113 women) with Poisson's regression after adjusting for age, body mass index, hypertension, diabetes mellitus, ratio of total cholesterol to high-density lipoprotein cholesterol, current smoking, and education level. LV hypertrophy was significantly predictive of incident CVD, and the association shown by analyses of matched propensity scores was similar in men and women (incidence rate ratio 1.88 vs 1.92, p = 0.97 for men, population-attributable risk 0.22 vs 0.26, p <0.07 for women). In the multivariate analysis, we found comparable effect estimates for LV hypertrophy (incidence rate ratio 1.66 vs 2.09, p = 0.55 for men; population-attributable risk 0.24 vs 0.32, p <0.07 for women). Thus, LV hypertrophy is a strong predictor of CVD in African-Americans, and the effect of LV hypertrophy on CVD is similar in men and women.
超声心动图测定的左心室（LV）肥厚可能是女性心血管疾病（CVD）比男性更强的危险因素，尽管尚不清楚所报道的性别差异是真实存在的还是归因于混杂因素。我们评估了从社区动脉粥样硬化风险研究的非裔美国人队列中收集的超声心动图左心室肥厚（定义为左心室质量/身高(2.7)≥51 g/m(2.7)）。在中位随访4.9年（四分位间距4.3至5.6年）期间确定了新发CVD事件（男性57例，女性62例），包括非致命性心肌梗死、心源性死亡、冠状动脉血运重建和中风。我们进行了两项分析。首先，我们根据倾向评分创建了340名患有左心室肥厚的男性和812名患有左心室肥厚的女性的匹配样本，并估计了特定性别的发病率比和人群归因风险。其次，我们在调整了年龄、体重指数、高血压、糖尿病、总胆固醇与高密度脂蛋白胆固醇的比值、当前吸烟情况和教育水平后，用泊松回归评估了完整队列（604名男性和1113名女性）。左心室肥厚是新发CVD的显著预测因素，匹配倾向评分分析显示的关联在男性和女性中相似（发病率比1.88对1.92，男性p = 0.97；人群归因风险0.22对0.26，女性p<0.07）。在多变量分析中，我们发现左心室肥厚的效应估计值相当（发病率比1.66对2.09，男性p = 0.55；人群归因风险0.24对0.32，女性p<0.07）。因此，左心室肥厚是非洲裔美国人CVD的有力预测因素，并且左心室肥厚对CVD的影响在男性和女性中相似。
