Which measures of adiposity predict subsequent left ventricular geometry? Evidence from the Bogalusa Heart Study

Abstract

Background and aims Left ventricular (LV) hypertrophy increases the risk of future cardiovascular events. The relationship between obesity in young adulthood and later LV geometry is unknown. We examined the association between long-term changes in measures of adiposity and subsequent LV geometry among 1073 young adults from the Bogalusa Heart Study. Methods and results Echocardiography-measured LV geometry was classified into normal (N = 796), concentric remodeling (N = 124), eccentric hypertrophy (N = 99), and concentric hypertrophy (N = 54) by integrating relative wall thickness and LV mass index. The mean age of our population was 38 years when the LV geometry was measured. Body mass index (BMI) increased by a mean of 4.9 kg/m2 over a median of 20 years, waist circumference (WC) by 10.9 cm over 17 years, waist/hip ratio by 0.02 over 10 years, waist/height ratio by 0.06 over 17 years, abdominal height by 0.9 cm over 10 years, body fat (BF) percentage by 12.7% over 20 years, and Visceral Adiposity Index by 0.30 over 17 years. In polytomous logistic regression models corrected for multiple comparisons, participants with one-standard-deviation increases in BMI,WC, waist/height ratio, and BF had 2.00 (95% confidence interval (CI): 1.53–2.61), 1.33 (1.06–1.68), 1.35 (1.07–1.70), and 1.60 (1.26–2.03) times the risk of eccentric hypertrophy, respectively, after adjustment for demographic, lifestyle, metabolic risk factors, and follow-up time. Likewise, the rates of change in BMI, WC, waist/height ratio, and BF were associated with eccentric hypertrophy. There was no association with concentric remodeling or concentric hypertrophy. Conclusions Our findings suggest that increases in BMI, WC, waist/height ratio, and BF were strong predictors of eccentric hypertrophy in middle age.

Dynamic Relation of Changes in Weight and Indices of Fat Distribution With Cardiac Structure and Function: The Dallas Heart Study

“…In contrast to our study and a prior study from MESA5 in which a concentric remodeling phenotype was predominant for all adiposity measures, the Bogalusa Heart Study concluded that increases in indices of both generalized and central adiposity were associated with eccentric LV hypertrophy but not concentric remodeling using echocardiography 34. One possible explanation for the disparate findings between studies may be due to the different demographics of the study populations: mean age 22 years and majority white participants in the Bogalusa Heart study compared with mean age 44 years and ≈50% black in the DHS.…”

Gender-specific contribution of cardiometabolic index and lipid accumulation product to left ventricular geometry change in general population of rural China

“…The prospective cohort Atherosclerosis Risk in Communities study (ARIC) noted that greater metric of abdominal obesity, defined by WC, constituted an independent risk factor for subclinical abnormalities in LV structure [ 42 ]. In contrast to a recent study from Bogalusa Heart Study in which an eccentric LVH but not concentric LVH was predominant for WC [ 15 ], the Dallas Heart Study and a report from South African community proposed that WC raised considerably the possibility of concentric LV remodeling phenotype, which is prognostically worse due to a high risk for cardiovascular death [ 10 , 16 ]. Furthermore, there have discrepant conclusions concerning the malefic health consequences of visceral adiposity index (VAI) as a valid estimate for the prediction of LV remodeling and geometry.…”

“…Current investigations of LV morphology have elucidated that individuals with more visceral adiposity predisposed to greater LVM/volume ratio and LVWT concurrent with a decrease in LVEDV, which represented the summation of multiple diverse aspects of concentric LV remodeling [ 17 , 18 ]. Conversely, Hu T and colleagues failed to support long-term increases, in both magnitude and velocity of VAI, as a marker associated with abnormal LV geometry [ 15 ]. Hence, it would be useful to embark on a novel and easily assessed marker of abdominal adiposity in clinical practice to stratify the risk of divergent cardiovascular structural and hemodynamic phenotypes given the paucity of efficient diastolic heart failure therapies.…”

“…There is a diverse geometric pattern of left ventricle adaptations to fat distribution, in view of adipose depots inherently involve disparate metabolic process, structural composition, and functional manifestation [ 14 ]. In this context, a sample of 1073 young individuals from Bogalusa Heart Study revealed that increases in body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were demonstrated to have independent influences on the development of eccentric LVH but not concentric LVH [ 15 ]. Interestingly, in a multiethnic cohort of 1262 adults from the Dallas Heart Study, the predominant impact of general or central adiposity on LV phenotype was concentric remodeling without additional ejection fraction change [ 16 ].…”

Comparison of Visceral Adiposity Index with Other Indices of Adiposity in Patients with Acute Myocardial Infarction

“…Measurement of the degree of visceral fat has become an important determinant of the degree of cardiovascular risk. 2 The gold standard assessment method for the estimation of visceral fat content has been Magnetic resonance imaging and Computerized tomography. However these methods are not pragmatic owing to the cost and time involved in their utilization.…”