Framingham risk score (FRS) underestimates risk in young adults. LV mass (LVM) relates to cardiovascular disease (CVD), with unclear value in youth. In a young biracial cohort, we investigate how FRS predicts CVD over 20 years and the incremental value of LVM. We also explore the predictive ability of different cut-points for hypertrophy.
We assessed FRS and echocardiography-derived LVM (indexed by BSA or height2.7) from 3980 African-American and white CARDIA participants (1990–1991); and followed over 20 years for a combined endpoint: cardiovascular death; nonfatal myocardial infarction, heart failure, cerebrovascular disease, and peripheral artery disease. We assessed the predictive ability of FRS for CVD and also calibration, discrimination, and net reclassification improvement for adding LVM to FRS.
Mean age was 30 ± 4 years, 46% males, and 52% white. Event incidence (n = 118) across FRS groups was, respectively, 1.3%, 5.4%, and 23.1% (p < 0.001); and was 1.4%, 1.3%, 3.7%, and 5.4% (p < 0.001) across quartiles of LVM (cut-points 117 g, 144 g, and 176 g). LVM predicted CVD independently of FRS, with the best performance in normal weight participants. Adding LVM to FRS modestly increased discrimination and had a statistically significant reclassification. The 85th percentile (≥ 116 g/m2 for men; ≥ 96 g/m2 for women) showed event prediction more robust than currently recommended cut-points for hypertrophy.
In a biracial cohort of young adults, FRS and LVM are helpful independent predictors of CVD. LVM can modestly improve discrimination and reclassify participants beyond FRS. Currently recommended cut-points for hypertrophy may be too high for young adults.
[Show abstract][Hide abstract] ABSTRACT: Abstract
Aims Antecedent blood pressure (BP) may contribute to cardiovascular disease (CVD) independent of current BP. Blood pressure is associated with left ventricular mass index (LVMI) which independently predicts CVD. We investigated the relationship between midlife BP from age 36 to 64 and LVMI at 60–64 years.
Methods and results A total of 1653 participants in the British 1946 Birth Cohort underwent BP measurement and echocardiography aged 60–64. Blood pressure had previously been measured at 36, 43, and 53 years. We investigated associations between BP at each age and rate of change in systolic blood pressure (SBP) between 36–43, 43–53, and 53–60/64 years on LVMI at 60–64 years. Blood pressure from 36 years was positively associated with LVMI. Association with SBP at 53 years was independent of SBP at 60–64 years and other potential confounders (fully adjusted β at 53 years = 0.19 g/m2; 95% CI: 0.11, 0.27; P < 0.001). Faster rates of increase in SBP from 43 to 53 years and 53 to 60/64 years were associated with increased LVMI. Similar relationships were seen for diastolic, pulse, and mean pressure. Rate of increase in SBP between 43–53 years was associated with largest change in LVMI (β at 43–53 years = 3.12 g/m2; 95% CI: 1.53, 4.72; P < 0.001). People on antihypertensive medication (43 years onwards) had greater LVMI even after adjustment for current BP (β at 43 years = 12.36 g/m2; 95% CI: 3.19, 21.53; P = 0.008).
Conclusion Higher BP in midlife and rapid rise of SBP in 5th decade is associated with higher LVMI in later life, independent of current BP. People with treated hypertension have higher LVMI than untreated individuals, even accounting for their higher BP. Our findings emphasize importance of midlife BP as risk factor for future CVD.
Blood pressure Left ventricular mass Left ventricular hypertrophy Echocardiography
European Heart Journal 09/2014; DOI:10.1093/eurheartj/ehu389 · 15.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: -Data are limited regarding the presence, distribution and extent of subclinical atherosclerosis in middle-aged populations.
-The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants aged 40-54 years (mean age 45.8 years, 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic and ilio-femoral territories by 2D/3D ultrasound and coronary artery calcification (CAC) by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or CAC≥1, was classified as focal (one site affected), intermediate (2-3 sites) or generalized (4-6 sites) after exploring each vascular site (right/left carotids, aorta, right/left ilio-femorals and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men; 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the ilio-femorals (44%), followed by carotids (31%) and aorta (25%), while CAC was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When assessing longer-term risk (30-year FHS), 83% of participants at high-risk had atherosclerosis, with 66% classified as intermediate or generalized.
-Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; nonetheless, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT01410318.
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