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Breyting á tíðni þykknunar vinstri slegils og horfur, samanburður milli karla og kvenna 1967-1992 : hóprannsókn Hjartaverndar

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Authors
Inga S. Þráinsdóttir
Þórður Harðarson
Guðmundur Þorgeirsson
Helgi Sigvaldason
Nikulás Sigfússon
Issue Date
2000-07-01

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Survival and trends of ocurrence of left ventricular hypertrophy, gender differences during 1967-1992. The Reykjavík Study
Citation
Læknablaðið 2000, 86(7/8):489-94
Abstract
Objective: We estimated the prevalence and incidence of left ventricular hypertrophy (LVH) in this large prospective cohort study of almost 20,000 participants and identified risk factors in them. Predictive factors of its appearance were evaluated along with morbidity and mortality calculations. Material and methods: LVH was defined as Minnesota Code 310 on ECG. Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. Risk factors at the time of the diagnosis of LVH were determined with logistic regression. Predictive factors for acquiring this ECG abnormality were determined by Poisson regression. The comparison cohort were all other participants in the Reykjavík Study stages I-V. Results: Two hundred ninety-seven men and 49 women were found to have LVH or 3.2% and 0.5%, respectively. The incidence was 25/1000/year among men and 6/1000/ year among women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure (odds ratio pr. mmHg (OR) 1.02; 95% confidence interval (CI): 1.01-1.03), age (OR pr. year: 1.04; 95% CI: 1.02-1.05), silent myocardial infarction (MI) (OR: 3.18; 95% CI: 1.39-7.27) and ST-T changes (OR: 3.06; 95% CI: 2.14-4.38) among men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure (incidence ratio (IR): 1.01; 95% CI: 1.01-1.02) and angina with ECG changes (IR: 2.33; 95% CI: 1.08-5.02) among men and systolic blood pressure among women (IR: 1.03; 95% CI: 1.01-1.04). In men severe smoking seemed to have a protective effect against developing LVH (IR: 0.36; 95% CI: 0.18-0.71). The risk for coronary mortality was significantly increased among women with hypertrophy (hazard ratio (HR): 3.07; 95% CI: 1.5-6.31) and their total survival was poorer with increasing time from diagnosis of LVH (HR: 2.17; 95% CI: 1.36-3.48). Conclusions: We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure among both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischemic heart disease. This could indicate that criteria for detecting LVH on ECG detect both mild and severe hypertrophy among men but only the severe hypertrophy cases among women. More sensitive ECG methods may have to be used to detect mild, moderate and severe LVH among both genders in order to differentiate the severity of LVH based on the ECG diagnosis.
Tilgangur: Áður hefur verið sýnt fram á að þykknun vinstri slegils ein og sér, óháð öðrum þekktum áhættuþáttum hjartasjúkdóma, er áhættuþáttur hjartasjúkdóms. Við mátum algengi og nýgengi þykknunar vinstri slegils (ÞVS) í hóprannsókn Hjartaverndar og mátum áhættuþætti þátttakenda með þykknun vinstri slegils. Forspárþættir þykknunar á vinstri slegli voru einnig athugaðir auk mats á dánartíðni og dánarorsökum þátttakenda. Efniviður og aðferðir: Þykknun vinstri slegils var skilgreind samkvæmt Minnesota kóda 310 á hjartarafriti. Þátttakendur með kódann 310 við fyrstu heimsókn tilheyrðu algengishópi og þeir sem síðar fengu kódann 310 nýgengishópi. Áhættuþættir við greiningu þykknunar á vinstri slegli voru metnir með fjölþáttagreiningu en forspárþætttir með Poisson aðhvarfsgreiningu. Til samanburðar voru aðrir þátttakendur í hóprannsókninni, áföngum I-V. Niðurstöður: Tvö hundruð níutíu og sjö karlar og 49 konur greindust með þykknun á vinstri slegli eða 3,2% karla og 0,5% kvenna. Nýgengi var 25 á 1000 á ári meðal karla og sex á 1000 á ári meðal kvenna. Algengi þykknunar á vinstri slegli jókst með auknum aldri meðal beggja kynja. Áhættuþættir við greiningu voru slagbilsþrýstingur, aldur, þögul kransæðastífla og ST-T breytingar á EKG meðal karla og slagbilsþrýstingur og aldur meðal kvenna. Forspárþættir fyrir tilkomu þykknunar á vinstri slegli voru hár slagbilsþrýstingur og hjartaöng án hjartarafritsbreytinga meðal karla og hár slagbilsþrýstingur meðal kvenna. Hins vegar virtust miklar reykingar karla verndandi gegn tilkomu þykknunar á vinstri slegli. Áhætta á kransæðadauða var marktækt aukin meðal kvenna (áhættuhlutfall 3,07; 95% vikmörk 1,50-6,31) en ekki meðal karla. Heildarlifun kvenna fór einnig versnandi eftir því sem lengri tími leið frá greiningu þykknunar á vinstri slegli (áhættuhlutfall 2,17; 95% vikmörk 1,36-3,48). Ályktun: Við teljum að þykknun á vinstri slegli og tilkoma þess síðar tengist aldri og háum slagbilsþrýstingi meðal beggja kynja. Konur með þykknun á vinstri slegli hafa verri horfur en aðrar konur og eru í þrefaldri hættu á að deyja úr kransæðasjúkdómi. Slík áhætta sást ekki meðal karla. Þetta gæti bent til þess að greining þykknunar á vinstri slegli á hjartarafriti sé ábótavant meðal kvenna og greini því einungis alvarlega þykknun á hjartaraafriti kvenna á meðan unnt sé að greina bæði væga og alvarlega þykknun vinstri slegils á hjartarafriti karla. Finna þarf næmari aðferðir á hjartarafriti til að greina þykknunina og alvarleika þykknunarinnar fyrir bæði karla og konur.
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