cular disease nearly 3-fold. 6 Although hypertension is more strongly associated with heart failure and stroke, it has been observed to account for a greater absolute and excess risk of CHD than for these other events. 6 A simi- lar result was observed for ECG-LVH. 7 Although the association between hypertension, LVH, and death has been well described, it is less clear whether LVH in the absence of hypertension is associated with increased CHD mortality rates. Data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study were used to examine the association between ECG-LVH and CHD death among a nationally representative sample of whites and blacks with and without hypertension. In addition, analyses were repeated for deaths associated with diseases of the heart. Methods The National Center for Health Statistics of the Centers for Disease Control and Prevention conducted the Second National Health and Nutrition Examination Survey between February 1976 and February 1980. NHANES II, a nationwide probability sample of approximately 28,000 persons, was designed to be representative of the civilian, noninstitutional- Left ventricular hypertrophy (LVH) is a strong risk fac- tor for cardiovascular disease. Numerous studies have found it to be associated with adverse cardiovascular outcomes including stroke, sudden death, myocardial infarction (MI), congestive heart failure, and coronary heart disease (CHD). 1-4 In addition, data from the Fram- ingham Heart Study and the Bronx Longitudinal Aging Study suggest that the presence of electrocardiographi- cally defined LVH (ECG-LVH) is an independent predic- tor of all-cause death. 5 Hypertension is a major risk factor for both LVH and cardiovascular disease. Among hypertensive patients, the presence of ECG-LVH increases the risk of cardiovas- From the a Department of Epidemiology, Rollins School of Public Health, Emory Uni- versity; and the b Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Cen- ters for Disease Control and Prevention. Submitted December 1, 1999; accepted August 22, 2000. Reprint requests: Wayne H. Giles, MD, MSc, Division of Adult and Community Health, CDC/NCCDPHP (Mailstop K-45), 4770 Buford Hwy, NE, Atlanta, GA 30341-3717. E-mail: HWG0@cdc.gov 4/1/111112 doi:10.1067/mhj.2000.111112 Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension David W. Brown, MSc, a Wayne H. Giles, MD, MSc, b and Janet B. Croft, PhD b Atlanta, Ga Background Although associations between hypertension, left ventricular hypertrophy (LVH), and coronary heart dis- ease (CHD) have been described, it is less clear whether LVH is associated with increased rates of CHD in the absence of hypertension. Methods We examined this association with Cox regression analyses of data from 7924 adults 25 to 74 years of age from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study (1976 to 1992). Covari- ates included age, race, sex, history of cardiovascular diseases and diabetes, cholesterol, body mass index, blood pressure, and smoking. Results During 16.8 follow-up years, there were 462 (26%) deaths from CHD (ICD-9 410-414) and 667 (38%) deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429). LVH prevalence was 13.3 per 1000 population. Hypertension prevalence was 29.1%. LVH prevalence was higher among hypertensive adults than among nor- motensive adults (29.9 vs 6.4 per 1000, P < .001). Persons with LVH were twice as likely to die of CHD (relative risk, 2.0; 95% confidence interval, 1.2, 3.5) and diseases of the heart (relative risk, 1.9; 95% confidence interval, 1.1, 3.0) after adjustment for hypertension and covariates. In age-adjusted predicted survival, probability plots for CHD, and diseases of the heart, normotensives with LVH had survival similar to hypertensive adults with LVH and lower survival than normotensive and hypertensive adults with no LVH. Conclusions Our results confirm previous findings that the presence of LVH is a strong predictor of future cardiovascu- lar death. Although LVH appears to be rare among normotensives, clinicians should be aware that such individuals may have an increased risk for death similar to that of hypertensive adults with LVH. (Am Heart J 2000;140:848-56.)