A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: The Strong Heart Study

• Published in: The American heart journal Vol. 141; no. 3; pp. 439 - 446
• Main Authors: Devereux, Richard B., Roman, Mary J., Paranicas, Mary, Lee, Elisa T., Welty, Thomas K., Fabsitz, Richard R., Robbins, David, Rhoades, Everett R., Rodeheffer, Richard J., Cowan, Linda D., Howard, Barbara V.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2001; Elsevier
• Subjects: Aged; Arizona; Biological and medical sciences; Body Weight; Cardiology. Vascular system; Coronary Disease - ethnology; Female; Heart; Heart Failure - ethnology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Indians, North American; Male; Medical sciences; Middle Aged; Multivariate Analysis; North Dakota; Oklahoma; Prevalence; South Dakota; Systole; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - ethnology; Human; Heart failure; Middle age; Dysfunction; Heart disease; Cardiovascular disease; Systole; Epidemiology; Elderly; Left ventricle
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2001.113223

Background Although clinical congestive heart failure (CHF) is increasingly common, few data document the prevalence and correlates of underlying left ventricular (LV) systolic dysfunction (D) in population-based samples. Methods Echocardiography was used in the second Strong Heart Study (SHS) examination to identify mild and severe LVD (LV ejection fraction [EF] 40%-54% and <40%, respectively) in 3184 American Indians. Results Mild and severe LVD were more common in men than women (17.4% vs 7.2% and 4.7% vs 1.8%) and in diabetic than nondiabetic participants (12.7% vs 9.1% and 3.5% vs 1.6%). Stepwise increases were observed from participants with normal EF to those with mild and severe LVD in age (mean 60 vs 61 and 63 years, P <.001), prevalence of overt CHF (2% vs 6% and 28%) and definite coronary heart disease (3% vs 11% and 32%), systolic pressure (129 vs 135 and 136 mm Hg), serum creatinine level (0.98 vs 1.34 and 2.16 mg/dL), and log urinary albumin/creatinine level (3.2 vs 3.7 and 4.7); a negative relation was seen with body mass index (31.1 vs 31.0 and 28.4 kg/m2) (all P <.001). In multivariate analyses lower LVEFs were independently associated with clinical CHF and coronary heart disease, lower myocardial contractility, male sex, hypertension, overweight, arterial stiffening (higher pulse pressure/stroke volume) and renal dysfunction (higher serum creatinine level), higher LV mass, and lower relative wall thickness. Conclusions LVD, present in approximately 14% of middle-aged to elderly adults, is independently associated with overt heart failure and coronary heart disease, male sex, hypertension, overweight, arterial stiffening, and renal target organ damage and, less consistently, with older age and diabetes. (Am Heart J 2001;141:439-46.)