ABSTRACT
Objective: To examine the relationship between left ventricular hypertrophy (LVH) and the incidence of acute coronary heart disease (CHD) and mortality in the modern era. Methods: We studied 16, 390 black and white participants free of clinical CHD from a US national sample. The independent prognostic value of ECG-LVH was determined by Cornell voltage (CV) for risk of incident acute CHD and total mortality overall and by race and sex. Results: 410 incident acute CHD events and 993 deaths occurred over a median follow-up of 4.8 years. CV LVH was associated with outcomes: more common in blacks (4.1%) than whites (1.2%) and in women (3.9%) than men (1.3%). However, men with CV LVH (HR 2.12 [95% CI 1.02-4.42) had greater risk for incident acute CHD than women (HR 1.29 [95% CI 0.79-2.11]) after adjusting for demographic, behavioral and clinical variables. By contrast, CV LVH conferred similar hazards for incident acute CHD among blacks (HR 1.63 [1.00-2.68; p=0.050]) and whites (HR 1.58 [95% CI 0.76-3.28; p=0.22]). Mortality associated with CV LVH was elevated overall (HR 1.31 [95% CI 1.00- 1.71]) and for blacks (HR 1.36 [95% CI 1.00-1.86]) but not whites (HR 1.16 [95% CI 0.70-1.94]), with similar risk for women (HR 1.24 [95% CI 0.92-1.67] and for men (HR 1.30 [95% CI 0.72-2.35]). Conclusion: In this contemporary cohort, CV LVH was significantly prognostic for incident acute CHD for men but not women and there was no evidence of race differences. However, CV LVH was significantly prognostic for total mortality for blacks but not whites without evidence of sex differences.
ABSTRACT
Background/Objective: Aspirin for primary prophylaxis is controversial. This study evaluated associations between prophylactic aspirin use and incident acute coronary heart disease (CHD) events. Methods and Results: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study was accessed for aspirin use examining black and white hazards for incident CHD, for men and women, each adjusting incrementally for sampling, sociodemographics, and CHD risk factors. Stratified models examined risks across strata of the Framingham risk score, and all-cause mortality. 23,949 participants (mean 64 yo), had 503 incident events over a 3.5 year follow-up. Prophylactic aspirin use was not associated with incident acute CHD, HR 1.05 (95% CI 0.86, 1.29). Modeling had little impact on the HR (1.09 {95% CI 0.89, 1.33) nor did the addition of risk factors (HR 1.00 {95% CI 0.81, 1.23). Aspirin use was not associated with incident CHD for any Framingham risk level. Findings were similar when including all aspirin users (not just those taking aspirin prophylactically), and when examining associations with all-cause mortality. There was no excess hospitalized bleeding in the aspirin users. Conclusion: Aspirin was not associated with lower risk for incident acute CHD overall, or within race, gender, or Framingham Risk Score.