Determinants of left ventricular hypertrophy in a cohort attending a medical clinic: A comparative analysis stratified by sex

Abstract

Left ventricular hypertrophy (LVH) is a significant cardiovascular complication in sub-Saharan Africa. However, sex-specific determinants of LVH in this population remain poorly understood. This study aimed to identify factors associated with LVH in a cohort attending medical clinic, stratified by sex. We conducted a cross-sectional analysis of 333 adults attending an outpatient clinic at Livingstone Teaching Hospital, Zambia. LVH was diagnosed by echocardiography. Data on demographics, clinical history (HIV, TB, hypertension) and metabolic profiles were collected. Univariable and multivariable logistic regression models were used to identify predictors of LVH in the overall cohort and in sex-stratified subgroups. p < 0.05 was considered statistically significant. Data from 333 participants were analysed. LVH was diagnosed in 75 participants (22.5%). In the overall cohort, independent factors associated with LVH were older age (AOR: 1.06 per year, 95% CI: 1.03-1.09, p < 0.0001), female sex (AOR: 2.31, 95% CI: 1.13-4.68, p = 0.020), hypertension (AOR: 2.52, 95% CI: 1.36-4.66, p = 0.003), and heart failure (AOR: 7.50, 95% CI: 1.85-30.3, p = 0.005). Sex-stratified analysis revealed distinct profiles: in males, LVH was significantly associated with older age (AOR: 1.06, 95% CI: 1.00-1.13, p = 0.030), hypertension (AOR: 3.70, 95% CI: 1.03-13.2, p = 0.044), and heart failure (AOR: 18.3, 95% CI: 1.60-209.0, p = 0.019), whereas in females, factors associated with LVH included older age (AOR: 1.06, 95% CI: 1.03-1.09, p < 0.0001), hypertension (AOR: 2.50, 95% CI: 1.21-5.18, p = 0.013), waist circumference (AOR: 1.05 per cm, 95% CI: 1.00-1.10, p = 0.047), and elevated cholesterol-HDL ratio (AOR: 1.53, 95% CI: 1.02-2.30, p = 0.036). LVH in this cohort was associated with age, female sex, hypertension, and heart failure. Factors associated with LVH differed by sex, with metabolic factors playing a more prominent role in women and hemodynamic factors in men. These findings underscore the importance of sex-specific cardiovascular risk assessment and tailored management strategies.