Echocardiographic left ventricular mass index predicts incident stroke in African Americans - Atherosclerosis risk in communities (ARIC) study

Background and Purpose - Despite theories that link stroke to left ventricular mass, few large, population- based studies have examined the predictive value of echocardiographically derived left ventricular mass index ( LVMI) to incident stroke in African Americans. Methods - Participants in the Jackson cohort of the Atherosclerotic Risk in Communities study have had extensive baseline evaluations, have undergone echocardiography during the third examination ( 1993 - 1995), and have been followed up for incident cardiovascular disease including ischemic stroke. Results - The study population consisted of 1792 participants, of whom 639 ( 35.7%) were men and the mean +/- SD age was 58.8 +/- 5.7 years. Compared with those without ischemic stroke, those with ischemic stroke had a higher frequency of hypertension ( 85.6% vs 58.7%) and diabetes ( 46.9% vs 21.0%). Left ventricular hypertrophy was more prevalent in those with stroke ( 62.2% vs 38.6%). During a median follow- up of 8.8 years, 98 incident strokes occurred ( 6.5 per 1000 person- years). LVMI was independently associated with stroke after adjusting for age, sex, hypertension, systolic blood pressure, smoking, diabetes, total to HDL cholesterol ratio, body mass index, and low left ventricular ejection fraction ( adjusted hazard ratio per 10 g/ m(2.7) increment of LVMI = 1.15; 95% CI, 1.02 to 1.28). The relation remained statistically significant after adding left atrial size and mitral annular calcification to the multivariable model. Conclusions - In this large, population- based African American cohort, we found that echocardiographic LVMI was an independent predictor of incident ischemic stroke even after taking into account traditional clinical risk factors.