Læknablaðið - 15.07.2000, Blaðsíða 13

FRÆÐIGREINAR / HJARTALÆKNINGAR
Breyting á tíðni þykknunar vinstri slegils
og horfur, samanburður milli
karla og kvenna 1967-1992
Hóprannsókn Hjartaverndar
Inga S.
Þráinsdóttir'
Þórður
Harðarson2
Guðmundur
Þorgeirsson1,2
Helgi Sigvaldason'
Nikulás Sigfússon1
Frá ‘Rannsóknarstöð Hjarta-
verndar, 2lyflækningadeild
Landspítalans.
Fyrirspurnir, bréfaskipti:
Nikulás Sigfússon, Rann-
sóknarstöð Hjartaverndar,
Lágmúla 9,108 Reykjavík.
Netfang:
n.sigfusson@hjartavernd.is
Lykilorð: þykknun vinstri
slegils, faraldsfrœði,
kynjamunur.
Ágrip
Tilgangur: Aður 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 þykknun-
ar 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 hjarta-
rafriti. 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 að-
hvarfsgreiningu. Til samanburðar voru aðrir þátttak-
endur 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. Al-
gengi 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 slagbils-
þrýstingur og aldur meðal kvenna. Forspárþættir fyrir
tilkomu þykknunar á vinstri slegli voru hár slagbils-
þrýstingur og hjartaöng án hjartarafritsbreytinga
meðal karla og hár slagbilsþrýstingur meðal kvenna.
Hins vegar virtust miklar reykingar karla verndandi
ENGLISH SUMMARY
Þráinsdóttir IS, Harðarson Þ, Þorgeirsson G,
Sigvaldason H, Sigfússon N
Survival and trends of ocurrence of left
ventricular hypertrophy, gender differences during
1967-1992. The Reykjavík Study
Læknablaðið 2000; 86: 489-94
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 calcu-
lations.
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 deve-
loped it between subsequent visits were incidence cases.
Risk factors at the time of the diagnosis of LVH were de-
termined with logistic regression. Predictive factors for ac-
quiring this ECG abnormality were determined by Poisson
regression. The comparison cohort were all other partici-
pants in the Reykjavík Study stages l-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 (Cl); 1.01-1.03), age (OR pr.
year: 1.04; 95% Cl: 1.02-1.05), silent myocardial infarction
(Ml) (OR: 3.18; 95% Cl: 1.39-7.27) and ST-Tchanges (OR:
3.06; 95% Cl: 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% Cl: 1.01-1.02) and
angina with ECG changes (IR: 2.33; 95% Cl: 1.08-5.02)
among men and systolic blood pressure among women
(IR: 1.03; 95% Cl: 1.01-1.04). In men severe smoking
seemed to have a protective effect against developing LVH
(IR: 0.36; 95% Cl: 0.18-0.71). The riskfor coronary morta-
lity was significantly increased among women with hyper-
trophy (hazard ratio (HR): 3.07; 95% Cl: 1.5-6.31) and their
total survival was poorer with increasing time from diag-
nosis of LVH (HR: 2.17; 95% Cl: 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 differen-
tiate the severity of LVH based on the ECG diagnosis.
Keywords: left ventricular hypertrophy, epidemiology,
gender difference.
Correspondance: Nikulás Sigfússon. E-mail: n.sigfusson
©hjartavernd.is
Læknablaðið 2000/86 489