Author + information
- Received October 17, 2017
- Revision received December 26, 2017
- Accepted December 28, 2017
- Published online March 26, 2018.
- Matthew Nayor, MD, MPHa,b,∗ (, )
- Danielle M. Enserro, PhDc,
- Vanessa Xanthakis, PhDa,d,e,
- Martin G. Larson, SDa,e,
- Emelia J. Benjamin, MD, ScMa,c,f,
- Jayashri Aragam, MDg,h,
- Gary F. Mitchell, MDi and
- Ramachandran S. Vasan, MDa,d,f
- aFramingham Heart Study, Framingham, Massachusetts
- bCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- cDepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- dSection of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- eDepartment of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- fCardiology Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- gCardiovascular Division, Veterans Administration Hospital, West Roxbury, Massachusetts
- hHarvard Medical School, Boston, Massachusetts
- iCardiovascular Engineering, Inc., Norwood, Massachusetts
- ↵∗Address for correspondence:
Dr. Matthew Nayor, Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN #3185, Boston, Massachusetts 02114.
Objectives This study sought to evaluate the course, correlates, and prognosis of longitudinal changes in left ventricular (LV) diastolic dysfunction (DD) in the community-based Framingham Heart Study.
Background Relationships of clinical risk factors to longitudinal progression of DD are incompletely understood.
Methods Diastolic function was assessed by echocardiography performed at consecutive examinations (visits 1 and 2, mean interval 5.6 years) in 1,740 participants (64 ± 8 years of age at visit 1, 59% women) with normal LV systolic function and no atrial fibrillation.
Results Of 1,615 individuals with normal-to-mild DD at visit 1, 198 (12%) progressed to ≥ moderate DD at visit 2. Progression was more likely in women and with advancing age (p < 0.0001). Of 125 individuals with ≥ moderate DD at visit 1, 25 (20%) regressed to normal-to-mild DD by visit 2. Regression of DD was associated with younger age (p < 0.03). In stepwise regression models, age, female sex, baseline and changes in systolic blood pressure, diastolic blood pressure, body mass index, serum triglycerides, and diabetes were positively associated with worsening diastolic function (all p < 0.05). Noncardiac comorbidity tracked with progressive DD. Cardiovascular disease (CVD) or death events occurred in 44 of 1,509 participants free of CVD at visit 2, during 2.7 ± 0.6 years of post-visit 2 follow-up. Presence of ≥ moderate DD was associated with higher risk (age- and sex-adjusted hazard ratio for CVD or death: 2.14; 95% confidence interval: 1.06 to 4.32; p = 0.03).
Conclusions In a community-based cohort of middle-aged to older adults, cardiometabolic risk factors and noncardiac comorbidities were associated with DD progression. Moderate or worse DD was associated with higher risk of CVD or death.
Supported by National Heart, Lung, and Blood Institute (NHLBI) Framingham Heart Study contracts N01-HC-25195 and HHSN268201500001I; grants HL076784, G028321, HL070100, HL060040, HL080124, HL071039, HL077447, HL107385, HL126136, 2R01HL092577, 1R01HL128914, 1P50HL120163, and 2-K24-HL04334. Dr. Nayor is supported by NHLBI grant K23-HL138260 and training grant U10HL110337. Dr. Cooper is supported by the United Negro College Fund/Merck Science Initiative. Dr. Vasan is supported by an Evans Scholar award and the Jay and Louis Coffman Foundation from the Department of Medicine, Boston University School of Medicine. Dr. Mitchell owns Cardiovascular Engineering, Inc.; and has received grants and honoraria from and is a consultant for Novartis, Merck Sharp and Dohme, Servier, and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 17, 2017.
- Revision received December 26, 2017.
- Accepted December 28, 2017.
- 2018 American College of Cardiology Foundation