2897Sex difference in cardiovascular risk is offset by presence of left ventricular hypertrophy

Abstract

Background: The notion that women have better cardiovascular (CV) outcome than men is consolidated by strong evidence. However whether or not this sexspecific protection persists also in the presence of hypertensive target organ damage such as left ventricular (LV) hypertrophy (LVH) is unclear. Purpose: Our objective was to assess whether the presence of LVH alters the outcome difference between men and women with treated arterial hypertension. Methods: Clinical, echocardiographic and outcome data from 5,395 women and 6,937 men free from prevalent CV disease from the prospective Campania Salute Network registry were used. Median follow-up was 49 months. LVH was identified from prognostically validated sex-specific cut-off values of LV mass index (47 g/m2.7 for women and 50 g/m2.7 for men). The impact of sex on incident major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation) was assessed in the presence or absence of LVH, using Cox regression analysis and reported as hazard rates (HR) and 95% confidence intervals (CI). Results: Women were older, more obese, had higher systolic blood pressure (BP), total and high density lipoprotein cholesterol, and lower diastolic BP, serum triglycerides and glomerular filtration rate compared to men (all p<0.01), while the prevalence of smoking did not differ. LVH was more prevalent in women than men (43.2 vs. 32.4%, p<0.001). Incident MACE occurred in 3.5% of men and 2.8% of women during follow-up (p=0.040). In Cox regression analysis among subjects without LVH, adjusting for baseline differences in CV risk factors, women without LVH had a 32% lower HR for MACE (95% CI 0.49-0.95), p=0.025) than men without LVH (Figure, Panel A). Running the same model in subjects with LVH, women with LVH did not have a significantly lower HR for MACE (HR 0.79 [0.59-1.06], p=0.110) than men with LVH (Figure Panel B). Conclusions: In hypertension, presence of LVH attenuates the sex difference in CV risk. (Figure presented).