High prevalence of echocardiographic left ventricular hypertrophy and mortality in South Asians in the UK: E-ECHOES community study

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

5A.1

Presenter:

Eduard Shantsila

Co-authors:

Eduard Shantsila1, Alena Shantsila2, Nefyn Williams1, Gregory YH Lip2, Paramjit S Gill3

Author institutions:

1Department of Primary Care and Mental Health, University of Liverpool, UK 2Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK. 3Academic Unit of Primary Care Warwick Medical School University of Warwick Coventry, UK

Problem

Ethnic minority groups, including people of South-Asian origin, suffer from high cardiovascular morbidity and mortality, contributed by health inequalities. Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, and the scale of the problem in South Asian communities is unknown. Left ventricular hypertrophy (LVH) is a measure of target organ damage related to uncontrolled hypertension and can be accurately assessed by echocardiography. The study aimed to assess prevalence of LVH in South Asian community and its impact on mortality.

Approach

This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES) (age ≥45 years). Echocardiographic data were used to calculate left ventricular mass index (LVMI) following recommendations of the British Society of Echocardiography. LVH was established as increased LVMI. Predictive value of LVH overall and cardiovascular mortality was assessed using logistic regression (univariate and adjusted for age and sex). Statistical analyses were done using Python 3.9 (Pandas, Numpy, Scipy and Statsmodels libraries).

Findings

The included 3200 people of South Asian origin (age 59±10 years, 52% women, 45% had a history of hypertension). There were 182 deaths, including 64 cardiovascular deaths during a follow up of 5.8±1.0 years. Increased LVMI was found in 1952 people (61%, mild LVH n=518 [16%], moderate LVH n=451 [14%], severe LVH n=983 [31%], based on LVMI).

Among those with LVH, 940 patients [48%] did not have a diagnosis of hypertension. LVH was as associated with increased overall mortality (univariate odds ratio [OR] 2.34, 95% confidence interval [CI] 1.66-3.90, p<0.001, adjusted OR 1.70, 95% CI 1.17-2.46, p<0.005) and cardiovascular mortality (univariate OR 3.52, 95% CI 1.79-6.94, p<0.001, adjusted OR 2.65, 95% CI 1.33-5.28, p<0.005).

Consequences

People of South Asian origin have a very high rate of complicated (i.e., LVH) hypertension, often non-diagnosed. The presence of LVH is linked to high overall and cardiovascular mortality. There is a clear need to improve community detection and management of hypertension in ethnic minority groups in the UK to address health inequalities.

Submitted by:

Eduard Shantsila