An underappreciated coronary risk factor

Left ventricular hypertrophy is often assumed to be little more than a marker for hypertension. In fact, the relation between diastolic or systolic blood pressure and left ventricular mass is not always close.1 2 Left ventricular hypertrophy is an independent risk factor for myocardial infarction and death in men and women with hypertension3 4 and in asymptomatic subjects with normal blood.5 6 In hypertensive patients it is a stronger coronary risk factor than casual blood pressure readings.

Early data from the Framingham study showed that patients with ST-T repolarisation abnormalities (“strain”) on the electrocardiogram had a sixfold increase in cardiac deaths over a 20 year follow up period.7

Echocardiography, however, is 5-10 times more sensitive than the electrocardiogram and detects left ventricular hypertrophy in 25-30% of all hypertensive patients.2 In such patients, myocardial infarction or death occurs at the rate of 4.6 events per 100 patient years, three times the risk in patients with hypertension and normal left ventricular mass.3 Women are not spared this increased risk.4 Even in asymptomatic subjects with normal blood pressure, increased left ventricular mass emerges as a risk factor for coronary disease, cardiac death, and all cause mortality.6 The relative risk of all cause mortality is 1.5 in men and 2.0 …