Presence of 2-4 subclinical cardiac changes doubled CVD risk (HR 2.39) in individuals with SBP 130-139 mmHg compared to SBP≥140 mmHg with no changes.
Does the presence of subclinical cardiac changes on echocardiogram predict incident cardiovascular events across different systolic blood pressure levels in community individuals free of baseline CVD?
The presence of subclinical cardiac changes on echocardiogram independently predicts cardiovascular events and can refine risk stratification to guide blood pressure management in primary prevention.
Abstract Objective This study aimed to investigate whether presence of subclinical cardiac changes on echocardiogram can help identify community individuals free of cardiovascular disease (CVD) at higher risk for CVD event across systolic blood pressure (SBP) levels. Methods Participants from Guangdong Province of the China PEACE Million Persons Project were grouped according to baseline SBP levels ( 130, 130-139, and ≥ 140 mmHg) and further stratified by the number of prevalent subclinical cardiac changes (0, 1, and 2-4). Cox regression models were applied to estimate hazard ratios for incident CVD event (coronary heart disease, myocardial infarction, stroke, heart failure, or cardiovascular death) across combined subclinical cardiac changes and/or SBP levels, adjusting for baseline CVD risk factors and medications use. We also calculated a 3-year number needed to treat (NNT3) to prevent 1 CVD event for each combined SBP (120-139, 140-159, or ≥160 mm Hg) and number of prevalent subclinical cardiac changes, assuming 12% relative risk reduction in CVD event according to the ESPRIT trial. Results There were 15825 participants (age: 56.3±9.7 years; 59.7% women) with 1472 CVD events over a median follow-up of 3.6 years. Within each SBP levels, a higher number of subclinical cardiac changes (1 or 2-4 compared with 0) was associated with a graded increased risk for CVD event (Figure 1A). Compared to those with SBP ≥ 140 mmHg and 0 subclinical cardiac change, individuals with SBP of 130-139 mmHg and 2-4 subclinical cardiac changes had a hazard ratio of 2.39 (95% CI 1.69, 3.38) for CVD event (Figure 1B). Overall, subclinical cardiac changes demonstrated the greatest value when NNT3 was considered in participants with SBP 120-159 mm Hg. For example, among participants with SBP 120-139 mm Hg, those with 0 subclinical cardiac change had a much higher NNT3 of 24 compared with those within same BP but who had 2-4 subclinical cardiac changes (NNT3 of 8). Conclusion Presence of subclinical cardiac changes is independently associated with CVD event across SBP levels and helps identify subjects at the highest risk. Future studies are needed to evaluate use of echocardiogram-based strategies for CVD risk assessment to guide the initiation or intensification of BP treatment.
Cai et al. (2025) studied this question. Presence of 2-4 subclinical cardiac changes doubled CVD risk (HR 2.39) in individuals with SBP 130-139 mmHg compared to SBP≥140 mmHg with no changes.