ORIGINAL ARTICLE The increased prevalence of left ventricular hypertrophy and concentric remodeling in UK Indian Asians compared with European Whites NS Chahal 1,2 , TK Lim 1 , P Jain 2 , JC Chambers 3 , JS Kooner 2 and R Senior 1,2 Individuals of Indian Asian ethnicity living in the UK have at least a 50% excess of cardiovascular disease (CVD) mortality compared with European whites, yet there are no validated tools capable of identifying this excess risk. Left ventricular hypertrophy (LVH) is a powerful prognosticator for future CVD events but its prevalence in Indian Asians is unknown. We examined the prevalence of LVH and the degree of concentric remodeling amongst healthy UK Indian Asians compared with European whites recruited to the LOLIPOP (London Life Sciences Prospective Population) study. Transthoracic echocardiography was performed in 2127 subjects aged 35–75 years without history of clinical CVD events. The prevalence of LVH was defined and relative wall thickness was calculated to provide a measure of concentric remodeling. The prevalence of LVH was significantly higher amongst Indian Asian men as compared with European white men, with an unadjusted odds ratio (OR) of 1.8 (95% CI: 1.4–2.6). Following adjustment for clinical and hemodynamic variables, the magnitude of this effect increased (OR 2.8, 95% CI: 1.9–4.2). The degree of concentric remodeling was higher amongst Indian Asians as compared with European whites (adjusted relative wall thickness for men: 0.41 vs 0.39, Po0.001; women: 0.40 vs 0.38, Po0.01). An almost threefold higher prevalence of LVH amongst Indian Asian men and a greater degree of concentric remodeling amongst Indian Asian men and women was evident. Investigation of the mechanisms underlying the pathogenesis of LV remodeling and blood pressure etiology may help redress the excess CVD mortality observed in Indian Asians. Journal of Human Hypertension (2013) 27, 288–293; doi:10.1038/jhh.2012.50; published online 29 November 2012 Keywords: hypertension; Indian Asian ethnicity; left ventricular hypertrophy INTRODUCTION Amongst Indian Asians living in the United Kingdom, cardiovas- cular disease mortality rates remain at least 50% higher than, and in some subgroups over twice, that of the native population. 1,2 As yet there are no plausible mechanisms or validated tools capable of identifying their excess risk as compared with European whites. Although Indian Asians are more susceptible to metabolic syndrome, hence a greater risk of developing type-2 diabetes and hypertension, the overall burden of ‘traditional’ cardiovascular risk factors tend to be lower amongst Indian Asians compared with European whites. 3,4 Left ventricular (LV) hypertrophy (LVH) is a form of cardiac remodeling strongly associated with major cardiovascular events independent of blood pressure (BP), known risk factors and coronary artery disease. 5 Although disparities between ethnic groups in this important phenotype have been demonstrated, 6,7 the prevalence of LVH amongst Indian Asians remains unknown. The pattern of LV remodeling may also carry independent prognostic information to LVH. 8 Hypertrophic and non- hypertrophic concentric remodeling, in particular, appear to be associated with greatest risk of future cardiovascular events. 9,10 However, there is again no prospective data collected on this phenotype amongst Indian Asians, either in the United Kingdom or elsewhere. We compared the prevalence of LVH, degree of concentric remodeling and quantitative measures of LV function between the United Kingdom Indian Asians and European whites recruited into the LOLIPOP (London Life Sciences Prospective Population) study. MATERIALS AND METHODS The methodology study design has been described previously. 11,12 Briefly, we recruited 2164 Indian Asian and European white subjects, aged 35–74 years and free from clinical cardiovascular disease, between August 2004 and November 2007 from the LOLIPOP study. LOLIPOP is an ongoing population-based study of B30 000 Indian Asian and European white men and women recruited from the lists of 58 General Practitioners in West London. Indian Asian ethnicity was defined as an individual having all four grandparents born in the Indian subcontinent (India, Pakistan and Bangladesh). The study was approved by the Northwick Park and Ealing Hospitals Research Ethics Committees. Consenting subjects provided a full medical history and underwent physical assessment including office BP, height and weight measurement for body surface area (BSA) and body mass index determination, bioimpedance for adipose and lean body mass (LBM) estimation (Tanita Body Composition Analyzer, Tokyo, Japan) and an electrocardiogram. Blood pressure assessment Office BP was measured in a seated position using an automated device, with the average of three separate measurements at 1-min intervals 1 Department of Cardiovascular Medicine, Northwick Park Hospital, Royal Brompton Hospital, Harrow, London, UK; 2 Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, UK and 3 Department of Epidemiology and Public Health, Imperial College London, London, UK. Correspondence: Professor R Senior, Department of Cardiovascular Medicine, Royal Brompton Hospital, London SW3 6NP, UK. E-mail: roxysenior@cardiac-research.org Received 3 July 2012; revised 21 September 2012; accepted 16 October 2012; published online 29 November 2012 Journal of Human Hypertension (2013) 27, 288–293 & 2013 Macmillan Publishers Limited All rights reserved 0950-9240/13 www.nature.com/jhh