Community echocardiographic left ventricular hypertrophy and mortality in South Asians in the UK: E-ECHOES study

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England. Background People of South-Asian origin have high cardiovascular morbidity, contributed by health inequalities. Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, but its scale in South Asian communities is unknown. Left ventricular hypertrophy (LVH) on echocardiography is a measure of target organ damage related to uncontrolled hypertension. The study aims to assess prevalence of LVH in South Asian community and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Methods Left ventricular mass index (LVMI) was calculated using echocardiography. LVH was established as increased LVMI. Predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. Results The study included 3200 South Asians (age 59±10, 52% women, 45% had a history of hypertension). There were 182 deaths, including 64 cardiovascular deaths during a 5.8±1.0-year follow-up. LVH was found in 1568 (49%). In those with LVH, 705 (45%) did not have a diagnosis of hypertension. On Cox regression LVH was independently associated with all-cause mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.01-1.88), cardiovascular mortality (HR 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%. Conclusion South Asians in the UK have a very high prevalence of hypertension which is often underdiagnosed and poorly controlled, leading to LVH and excess in overall and cardiovascular mortality. The findings call for more effective screening and management of hypertension with lower BP targets.