Author + information
- Received December 13, 2013
- Revision received March 5, 2014
- Accepted March 17, 2014
- Published online October 1, 2014.
- Satoru Kishi, MD∗,
- Anderson C. Armstrong, MD∗,
- Samuel S. Gidding, MD†,
- Laura A. Colangelo, MS‡,
- Bharath A. Venkatesh, PhD∗,
- David R. Jacobs Jr., PhD§,
- J. Jeffery Carr, MD, MSc‖,
- James G. Terry, MS¶,
- Kiang Liu, PhD‡,
- David C. Goff Jr., MD, PhD# and
- João A.C. Lima, MD∗∗ ()
- ∗Johns Hopkins University, Baltimore, Maryland
- †Nemours Cardiac Center, Wilmington, Delaware
- ‡Northwestern University, Chicago, Illinois
- §University of Minnesota School of Public Health, Minneapolis, Minnesota
- ‖Vanderbilt University School of Medicine, Nashville, Tennessee
- ¶Wake Forest University School of Medicine, Winston-Salem, North Carolina
- #Colorado School of Public Health, Aurora, Colorado
- ↵∗Reprint requests and correspondence:
Dr. João A.C. Lima, Johns Hopkins University School of Medicine, Division of Cardiology, 600 North Wolfe Street, Blalock 524, Baltimore, Maryland 21287-8222.
Objectives The goal of this study was to investigate the relationship of body mass index (BMI) and its 25-year change to left ventricular (LV) structure and function.
Background Longstanding obesity may be associated with clinical cardiac dysfunction and heart failure. Whether obesity relates to cardiac dysfunction during young adulthood and middle age has not been investigated.
Methods The CARDIA (Coronary Artery Risk Development in Young Adult) study enrolled white and black adults ages 18 to 30 years in 1985 to 1986 (Year-0). At Year-25, cardiac function was assessed by conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). Twenty-five–year change in BMI (classified as low: <27 kg/m2 and high: ≥27 kg/m2) was categorized into 4 groups (Low-Low, High-Low, Low-High, and High-High). Multiple linear regression was used to quantify the association between categorical changes in BMI (Low-Low as reference) with LV structural and functional parameters obtained in middle age, adjusting for baseline and 25-year change in risk factors.
Results The mean BMI was 24.4 kg/m2 in 3,265 participants included at Year-0. Change in BMI adjusted for risk factors was directly associated with incipient myocardial systolic dysfunction assessed by STE (High-High: β-coefficient = 0.67; Low-High: β-coefficient = 0.35 for longitudinal peak systolic strain) and diastolic dysfunction assessed by TDI (High-High: β-coefficient = −074; Low-High: β-coefficient = −0.45 for e′) and STE (High-High: β-coefficient = −0.06 for circumferential early diastolic strain rate). Greater BMI was also significantly associated with increased LV mass/height (High-High: β-coefficient = 26.11; Low-High: β-coefficient = 11.87).
Conclusions Longstanding obesity from young adulthood to middle age is associated with impaired LV systolic and diastolic function assessed by conventional echocardiography, TDI, and STE in a large biracial cohort of adults age 43 to 55 years.
- left ventricular function
- left ventricular remodeling
- risk factors
- speckle tracking echocardiography
- tissue Doppler imaging
The CARDIA study was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C and HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). The CARDIA study is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). The manuscript of this paper was reviewed by CARDIA for scientific content. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 13, 2013.
- Revision received March 5, 2014.
- Accepted March 17, 2014.
- American College of Cardiology Foundation