Eva Gerdts1, Raffaele Izzo2, Costantino Mancusi3, Maria Angela Losi3, Maria Virginia Manzi2, Grazia Canciello2, Nicola De Luca2, Bruno Trimarco3, Giovanni de Simone2. 1. Department of Clinical Science, University of Bergen, Norway; Hypertension Research Center, Federico II University Hospital, Naples, Italy. Electronic address: eva.gerdts@med.uib.no. 2. Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy. 3. Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Abstract
BACKGROUND: In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). METHODS: 12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/m2.7 in women and >50g/m2.7 in men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). RESULTS: The cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients without LVH (n=7764), women had a 35% lower hazard rate (HR) for MACE (n=179) than men (95% confidence interval [CI] 0.44-0.96, p=0.031) in Cox regression analysis adjusting for cardiovascular risk factors and antihypertensive treatment during follow up. In contrast, among patients with LVH (n=4565), women had a similar HR for MACE as men (HR 0.94 [95% CI 0.69-1.30], p=0.720). CONCLUSION: This study demonstrates that presence of LVH in hypertension offsets the female sex-protection in cardiovascular risk. Thus among hypertensive subjects with LVH, women and men have comparable cardiovascular risk.
BACKGROUND: In general, women have lower risk for cardiovascular disease. We tested whether this sex-specific protection persists also in the presence of hypertensive left ventricular hypertrophy (LVH). METHODS: 12,329 women and men with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a median of 4.1years. Subjects were grouped according to the absence or the presence of LVH identified by echocardiography using validated sex-specific cut-off values of LV mass index (>47g/m2.7 in women and >50g/m2.7 in men). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). RESULTS: The cardiovascular risk profile accompanying LVH did not differ between sexes, but presence of obesity and diabetes carried higher probability for LVH in women, and LVH was more prevalent in women than men (43.4 vs. 32.1%, p<0.001). Among patients without LVH (n=7764), women had a 35% lower hazard rate (HR) for MACE (n=179) than men (95% confidence interval [CI] 0.44-0.96, p=0.031) in Cox regression analysis adjusting for cardiovascular risk factors and antihypertensive treatment during follow up. In contrast, among patients with LVH (n=4565), women had a similar HR for MACE as men (HR 0.94 [95% CI 0.69-1.30], p=0.720). CONCLUSION: This study demonstrates that presence of LVH in hypertension offsets the female sex-protection in cardiovascular risk. Thus among hypertensive subjects with LVH, women and men have comparable cardiovascular risk.
Authors: Maria Angela Losi; Massimo Imbriaco; Grazia Canciello; Filomena Pacelli; Carlo Di Nardo; Raffaella Lombardi; Raffaele Izzo; Costantino Mancusi; Andrea Ponsiglione; Serena Dell'Aversana; Alberto Cuocolo; Giovanni de Simone; Bruno Trimarco; Emanuele Barbato Journal: J Cardiovasc Transl Res Date: 2019-09-05 Impact factor: 4.132
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