TY - JOUR
T1 - LV Mass as a Predictor of CVD Events in Older Adults with and Without Metabolic Syndrome and Diabetes
AU - Hoang, Khiet
AU - Zhao, Yanglu
AU - Gardin, Julius M.
AU - Carnethon, Mercedes
AU - Mukamal, Ken
AU - Yanez, David
AU - Wong, Nathan D.
N1 - Funding Information:
This research was supported by National Institutes of Health/National Heart, Lung, and Blood Institute contracts HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grant HL080295 and an additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by National Institute on Aging grant AG023629. Dr. Gardin is a member of the Speakers Bureau for Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A full list of principal Cardiovascular Health Study investigators and institutions can be found at CHS-NHLBI.org .
Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Objectives The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM). Background MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals. Methods We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors. Results Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality. Conclusions LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.
AB - Objectives The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM). Background MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals. Methods We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors. Results Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality. Conclusions LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.
KW - cardiovascular disease
KW - diabetes
KW - echocardiography
KW - left ventricular mass
KW - metabolic syndrome
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U2 - 10.1016/j.jcmg.2015.04.019
DO - 10.1016/j.jcmg.2015.04.019
M3 - Article
C2 - 26319502
AN - SCOPUS:84942601396
SN - 1936-878X
VL - 8
SP - 1007
EP - 1015
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -