Ishikawa Joji, Ishikawa Shizukiyo, Kabutoya Tomoyuki, Gotoh Tadao, Kayaba Kazunori, Schwartz Joseph E, Pickering Thomas G, Shimada Kazuyuki, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, School of Medicine 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Hypertension. 2009 Jan;53(1):28-34. doi: 10.1161/HYPERTENSIONAHA.108.118026. Epub 2008 Nov 17.
Left ventricular hypertrophy (LVH), assessed by ECG, is associated with an increased risk for cardiovascular events among hypertensive subjects. We evaluated the risks of LVH in a Japanese general population including normotensive and prehypertensive subjects. We measured ECG and blood pressure in 10 755 subjects at baseline. The Cornell product (CP) and Sokolow-Lyon (SL) voltage were calculated as markers of LVH (CP >or=2440 mm x ms and SL voltage >or=38 mm). Follow-up was performed for 10 years, and the incidence of stroke and myocardial infarction was evaluated. The prevalence of CP-LVH was 2.7% for normotensives, 5.2% for prehypertensives, and 11.0% for hypertensives, and the prevalence of SL-LVH was 5.0%, 8.2%, and 15.2%, respectively. In all of the subjects, CP-LVH and SL-LVH were both predictors of stroke (CP-LVH: hazard risk: 1.62, 95% CI: 1.19 to 2.20, P=0.002; SL-LVH: hazard risk: 1.29, 95% CI: 0.98 to 1.71, P=0.07) after adjustment for confounding factors but were not predictors of myocardial infarction. The adjusted hazard ratio of CP-LVH predicting stroke was especially high in the normotensives (hazard risk: 7.53; 95% CI: 3.39 to 16.77). In the normotensives, diabetes mellitus and hyperlipidemia were significant determinants of CP-LVH but not of SL-LVH. In all of the hypertensive subgroups (normotensives, prehypertensives, and hypertensives), the c-statistic for the equation predicting stroke increased when CP-LVH was added to the model but not when SL-LVH was added. In conclusion, both CP-LVH and SL-LVH are risk factors for stroke in the Japanese general population. CP-LVH is related to glucose abnormality, and its predictive value for stroke is seen even in normotensives and prehypertensives.
通过心电图评估的左心室肥厚（LVH）与高血压患者心血管事件风险增加相关。我们在包括血压正常和高血压前期患者的日本普通人群中评估了LVH的风险。我们在基线时测量了10755名受试者的心电图和血压。计算康奈尔乘积（CP）和索科洛 - 里昂（SL）电压作为LVH的指标（CP≥2440mm×ms且SL电压≥38mm）。进行了10年的随访，并评估了中风和心肌梗死的发生率。血压正常者中CP - LVH的患病率为2.7%，高血压前期患者为5.2%，高血压患者为11.0%，SL - LVH的患病率分别为5.0%、8.2%和15.2%。在所有受试者中，校正混杂因素后，CP - LVH和SL - LVH均为中风的预测因素（CP - LVH：风险比：1.62，95%可信区间：1.19至2.20，P = 0.002；SL - LVH：风险比：1.29，95%可信区间：0.98至1.71，P = 0.07），但不是心肌梗死的预测因素。CP - LVH预测中风的校正风险比在血压正常者中尤其高（风险比：7.53；95%可信区间：3.39至16.77）。在血压正常者中，糖尿病和高脂血症是CP - LVH的重要决定因素，但不是SL - LVH的决定因素。在所有高血压亚组（血压正常者、高血压前期患者和高血压患者）中，当将CP - LVH添加到模型中时，预测中风方程的c统计量增加，但添加SL - LVH时则不然。总之，CP - LVH和SL - LVH均为日本普通人群中风的危险因素。CP - LVH与血糖异常有关，其对中风的预测价值在血压正常者和高血压前期患者中也可见到。
