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Echocardiographically determined left ventricular(LV) hypertrophy may be a str onger risk factor of cardiovascular disease(CVD) for women than for men, althoug h it is unclear whether reported gender differences are real or attributable to confounding. We evaluated echocardiographic LV hypertrophy(defined as LV mass/he ight 2.7< 51 g/m2.7) collected from the African-American population of the Athe rosclerosis Risk in Communities Study. Incident CVD events(57 in men, 62 in wome n) were determined during a median follow-up of 4.9 years (interquartile range 4.3 to 5.6) and included nonfatal myocardial infarction, cardiac death, coronary revascularization, and stroke. We conducted 2 analyses. First, we created match ed samples of 340 men and 812 women who had LV hypertrophy based on propensity s core and estimated the gen-der-specific incidence rate ratios and population- attributable risks. Second, we evaluated the complete cohort(604 men and 1,113 w omen) with Poissons regression after adjusting for age, body mass index, hyper tension, diabetes mellitus, ratio of total cholesterol to high-density lipoprot ein cholesterol, current smoking, and education level. LV hypertrophy was signif icantly predictive of incident CVD, and the association shown by analyses of mat ched propensity scores was similar in men and women(incidence rate ratio 1.88 vs 1.92, p=0.97 for men, population-attributable risk 0.22 vs 0.26, p< 0.07 for w omen). In the multivariate analysis, we found comparable effect estimates for LV hypertrophy (incidence rate ratio 1.66 vs 2.09, p=0.55 for men; population-att ributable risk 0.24 vs 0.32, p< 0.07 for women). Thus, LV hypertrophy is a stron g predictor of CVD in African-Americans, and the effect of LV hypertrophy on CV D is similar in men and women.