Sex-Specific Association of Left Ventricular Hypertrophy With Cardiovascular Events in High-Risk of Cardiovascular Disease Population: Findings From the Sub-Cohort of China PEACE Million Persons Project

Sex differences significantly influence the prognosis of left ventricular hypertrophy (LVH). To investigate sex-specific differences in the incidence of major adverse cardiovascular event (MACE) among individuals with LVH, we enrolled 14 636 (mean age 57 years, women 59.1%) participants with high risk for cardiovascular diseases (CVD) from the sub-cohort of the China PEACE Million Persons Project. LVH was identified by echocardiography dividing left ventricular mass (LVM) by body surface area (BSA), height^1.7, or height^2.7 using validated sex-specific cutoff values. MACE was defined as a composite of coronary heart disease, myocardial infarction, strokes, heart failure, and/or cardiovascular death. During a median follow-up of 3.62 years, 1327 patients developed MACE. The prevalence of LVH was higher when indexing LVM to BSA and height^1.7 in women. Higher blood pressure (BP) and previous diabetes mellitus (DM) were associated with a higher risk of LVH in both genders, while aging and adiposity had a more hazardous impact in women than in men. Multivariable Cox regression analyses indicated an increasing risk between LVH and MACE exclusively in men. In individuals diagnosed with LVH, women exhibited a reduced risk for MACE. When indexing LVM to BSA, concentric hypertrophy (adjusted hazard ratio [aHR]: 1.73, 95% CI: 1.37–2.19; p < 0.001] and eccentric hypertrophy (aHR: 1.54, 95% CI: 1.06–2.25; p = 0.025) were significantly associated with MACE in men. In this population study, risk factors including BP, blood glucose, lipids level, and BMI should be managed strictly. Additionally, men should pay more attention to the occurrence of LVH, which had a greater association with MACE.