Joint influences of obesity, diabetes, and hypertension on indices of ventricular remodeling: Findings from the community-based Framingham Heart Study

Abstract

Introduction Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated. Materials and methods We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% women) who underwent echocardiographic measurements of left ventricular (LV) mass (LVM), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e’, left atrial end-systolic (peak) dimension (LASD) and emptying fraction (LAEF). We used multivariable generalized linear models to estimate the adjusted-least square means of these measures according to cross-classified categories of body mass index (BMI; normal, overweight and obese), hypertension (yes/no), and diabetes (yes/no). Results We observed statistically significant interactions of BMI category, hypertension, and diabetes with LVM, LVEF, GLS, and LAEF (p for all 3-way interactions <0.01). Overweight and obesity (compared to normal BMI), hypertension, and diabetes status were individually and conjointly associated with higher LVM and worse GLS (p<0.01 for all). We observed an increase of 34% for LVM and of 9% for GLS between individuals with a normal BMI and without hypertension or diabetes compared to obese individuals with hypertension and diabetes. Presence of hypertension was associated with higher LVEF, whereas people with diabetes had lower LVEF. Conclusions Obesity, hypertension, and diabetes interact synergistically to influence cardiac remodeling. These findings may explain the markedly heightened risk of heart failure and cardiovascular disease when these factors co-cluster.

Muscle Strength, but Not Muscle Mass, Is Associated with Left Ventricular Diastolic Function during Aging in Chinese

“…Consistent with a recent study in older people, 11) our study revealed that both RASM and grip strength were positively associated with LVM, but the association disappeared after the adjustment for the age, sex, BMI, WHR, smoking, drinking, history of hypertension, and T2DM, implying that the association may have been overwhelmed by other risk factors of higher LVM, such as obesity, hypertension, and T2DM. 18,19) Moreover, we found that left ventricular diastolic function demonstrated age-dependent decline, consistent with previous studies. 17,20) Left ventricular diastolic dysfunction characterized as a filling impairment of the left ventricle is regarded as a predictor of the development of HF.…”

Assessment of subclinical left ventricular systolic dysfunction in patients with type 2 diabetes: Relationship with HbA1c and microvascular complications

“…In addition, research based on the Framingham Heart Study has revealed the significant conjoint associations of hypertension and diabetes with GLS, suggesting a synergistic effects on the reduced GLS. 22 Ballo et al demonstrated that diabetes, but not hypertension, exerted a negative effect on LV systolic function. 23 The current study revealed that T2DM patients with reduced GLS preferentially suffered higher systolic blood pressure, compared with those with GLS ≥18%, further validating the adverse influence of hypertension on the subclinical myocardial injury.…”

Prediabeto Ir Diabeto Bei Širdies Ir Kraujagyslių Ligų Diagnostika Ir Prevencija

“…Jau Framingham tyrimo metu buvo nustatyta, kad sergantieji CD dažniau sirgo ŠKL, nei tie, kurie nesirgo CD. Tyrėjai to negalėjo paaiškinti įprastiniais rizikos veiksniais, o ypač didelio moterų, sirgusių CD, sergamumo ir mirtingumo, nebūdingo tipiškam ŠKL pasireiškimui [5]. Aterosklerozinė ŠKL sergantiesiems 2 tipo CD vidutiniškai pasireiškia 14,6 metų anksčiau ir pasireiškimas yra sunkesnis, nei pacientams, neturintiems hiperglikemijos [4].…”