title: LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes.
abstract: OBJECTIVE
  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.
authors: Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California.
authors: Khiet
authors: K
authors: Hoang
authors: Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California.
authors: Yanglu
authors: Y
authors: Zhao
authors: Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey.
authors: Julius M
authors: JM
authors: Gardin
authors: Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
authors: Mercedes
authors: M
authors: Carnethon
authors: Department of Medicine, Harvard University, Boston, Massachusetts.
authors: Ken
authors: K
authors: Mukamal
authors: Department of Biostatistics, University of Washington, Seattle, Washington.
authors: David
authors: D
authors: Yanez
authors: Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, Irvine, California. Electronic address: ndwong@uci.edu.
authors: Nathan D
authors: ND
authors: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology
keywords: cardiovascular disease; diabetes; echocardiography; left ventricular mass; metabolic syndrome