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(Hypertension. 2009;53:28.)
© 2009 American Heart Association, Inc.

Original Articles

Cornell Product Left Ventricular Hypertrophy in Electrocardiogram and the Risk of Stroke in a General Population

Joji Ishikawa; Shizukiyo Ishikawa; Tomoyuki Kabutoya; Tadao Gotoh; Kazunori Kayaba; Joseph E. Schwartz; Thomas G. Pickering; Kazuyuki Shimada; Kazuomi Kario for the Jichi Medical School Cohort Study Investigators Group

From the Division of Cardiovascular Medicine, Department of Internal Medicine (J.I., T.K., K.S., K. Kario), and Division of Community and Family Medicine, Center for Community Medicine (S.I.), Jichi Medical University School of Medicine, Tochigi, Japan; Center for Behavioral Cardiovascular Health (J.I. J.E.S., T.G.P.), Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY; Wara National Health Insurance Hospital (T.G.), Gifu, Japan; and Saitama Prefectural University (K. Kayaba), Saitama, Japan.

Correspondence to Joji Ishikawa, MD, PhD, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, School of Medicine 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. E-mail george{at}jichi.ac.jp

Left ventricular hypertrophy (LVH), assessed by ECG, is associated with an increased risk for cardiovascular events among hypertensive subjects. We evaluated the risks of LVH in a Japanese general population including normotensive and prehypertensive subjects. We measured ECG and blood pressure in 10 755 subjects at baseline. The Cornell product (CP) and Sokolow-Lyon (SL) voltage were calculated as markers of LVH (CP 2440 mmxms and SL voltage 38 mm). Follow-up was performed for 10 years, and the incidence of stroke and myocardial infarction was evaluated. The prevalence of CP-LVH was 2.7% for normotensives, 5.2% for prehypertensives, and 11.0% for hypertensives, and the prevalence of SL-LVH was 5.0%, 8.2%, and 15.2%, respectively. In all of the subjects, CP-LVH and SL-LVH were both predictors of stroke (CP-LVH: hazard risk: 1.62, 95% CI: 1.19 to 2.20, P=0.002; SL-LVH: hazard risk: 1.29, 95% CI: 0.98 to 1.71, P=0.07) after adjustment for confounding factors but were not predictors of myocardial infarction. The adjusted hazard ratio of CP-LVH predicting stroke was especially high in the normotensives (hazard risk: 7.53; 95% CI: 3.39 to 16.77). In the normotensives, diabetes mellitus and hyperlipidemia were significant determinants of CP-LVH but not of SL-LVH. In all of the hypertensive subgroups (normotensives, prehypertensives, and hypertensives), the c-statistic for the equation predicting stroke increased when CP-LVH was added to the model but not when SL-LVH was added. In conclusion, both CP-LVH and SL-LVH are risk factors for stroke in the Japanese general population. CP-LVH is related to glucose abnormality, and its predictive value for stroke is seen even in normotensives and prehypertensives.

Key Words: Cornell product • left ventricular hypertrophy • stroke event • cohort study