Clinical Heart and Vascular Center

Racial Differences in Malignant LVH and Incident HF

By Alana Lewis, M.D., Cardiology Fellow and James de Lemos, M.D., Professor of Internal Medicine

Lewis Headshot

Left ventricular hypertrophy (LVH) is an important preclinical abnormality that is associated with a higher risk of developing heart failure (HF). Prior work from our group has shown that individuals with evidence of LVH but normal cardiac biomarkers appear to have a favorable prognosis, whereas those with small elevations in troponin or N-terminal pro-brain natriuretic peptide (NT-proBNP) appear to be at high risk for HF, a group that we have termed “malignant LVH.” In our study presented at the 2019 AHA Scientific Sessions, we pooled data from three biracial cohort studies (the Atherosclerosis Risk in Communities Study, the Dallas Heart Study, and the Multi-Ethnic Study of Atherosclerosis) and tested the hypothesis that malignant LVH may contribute to racial disparities in HF risk.  

“Incident HF was notably higher among black vs. white participants; black men had the highest incidence and, strikingly, black women had a similar incidence of HF as white men.”

Alana Lewis, M.D., and James de Lemos, M.D.
de Lemos headshot

A major contribution of this pooled cohort study is the demonstration of important racial differences in the prevalence of the malignant LVH phenotype, which may play a role in racial disparities in HF incidence. The prevalence of malignant LVH was threefold higher among black participants than white participants. Incident HF was notably higher among black vs. white participants; black men had the highest incidence and, strikingly, black women had a similar incidence of HF as white men. The population risk attributable to malignant LVH was higher in black participants than white participants due to a markedly higher prevalence of malignant LVH. Mediation analyses suggest that a modest but significant proportion of the excess risk for HF among black men and women may be explained by the higher prevalence of malignant LVH in blacks. 

Lewis and de Lemos Stock


Taken together, these findings suggest that malignant LVH may contribute to racial disparities in HF risk among black individuals in the general population. Strategies to prevent development or attenuate risk associated with malignant LVH should be investigated as a strategy to lower HF risk in blacks and thereby mitigate racial disparities.

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Read more articles from our Physician Update AHA Edition.