University of Ibadan, Ibadan, Nigeria.
Medical University of South Carolina, Charleston, SC, USA.
Glob Heart. 2017 Jun;12(2):107-113.e5. doi: 10.1016/j.gheart.2017.01.001. Epub 2017 Mar 13.
Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown.
We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study.
SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques.
This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age <45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure > 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001).
The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry.
左心室肥厚（LVH）是否与中风具有相似的遗传和环境风险因素，或者只是中风的一个中间标志物，目前尚不清楚。
我们提出了一项研究计划和初步研究结果，旨在探索参与 SIREN（中风调查研究与教育网络）研究的非洲人 LVH 和中风的遗传和环境决定因素是否存在重叠。
SIREN 是一项跨国、多中心研究，涉及来自加纳和尼日利亚 9 个地点的急性中风患者和年龄、种族和性别匹配的对照组。使用标准技术收集和比较中风和 LVH 的基因组和环境风险因素以及其他相关表型。
本初步分析仅包括 725 名中风患者（平均年龄 59.1 ± 13.2 岁；54.3%为男性）。55%的中风患者存在 LVH，女性中 LVH 的比例更高（51.6% vs. 48.4%；p < 0.001）。LVH 患者更年轻（57.9 ± 12.8 岁 vs. 60.6 ± 13.4 岁；p = 0.006），且收缩压和舒张压均较高（167.1/99.5 mmHg vs. 151.7/90.6 mmHg；p < 0.001）。LVH 患者就诊时血压控制不佳的比例较高（76.2% vs. 57.7%；p < 0.001）。LVH 的独立显著预测因素为年龄 <45 岁（校正优势比 [AOR]：1.91；95%置信区间 [CI]：1.14 至 3.19）、女性（AOR：2.01；95% CI：1.44 至 2.81）和舒张压 > 90 mmHg（AOR：2.10；95% CI：1.39 至 3.19；p < 0.001）。
中风患者中 LVH 的患病率很高，尤其是年轻患者，提示 LVH 存在遗传成分。高血压是中风以及 LVH 的主要可改变危险因素。预计 SIREN 项目将阐明非洲人群中 LVH 和中风之间的多基因重叠（如果存在），从而将 LVH 确定为潜在的中间心血管表型和治疗靶点，为降低非洲裔人群中风风险的干预措施提供信息。
