Clinical Investigation
Cardiovascular Risk Assessment by Cardiovascular Ultrasound
Low Cardiovascular Risk Is Associated with Favorable Left Ventricular Mass, Left Ventricular Relative Wall Thickness, and Left Atrial Size: The CARDIA Study

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Background

Echocardiographic measures of left ventricular (LV) mass and relative wall thickness and left atrial (LA) size predict future cardiovascular morbidity and mortality. The aim of this study was to compare young adults with low cardiovascular risk (body mass index, 18.5–24.9 kg/m2; blood pressure < 120/80 mmHg; no tobacco use, no diabetes, and physical fitness) with those without these characteristics with regard to LV mass and relative wall thickness and LA size, to determine the protective effect of a healthy lifestyle on the development of these characteristics.

Methods

Cross-sectional assessment of 4059 black and white men and women aged 23 to 35 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study at the year 5-examination, when risk factors were measured, and echocardiography to assess LV mass and relative wall thickness were performed. Physical fitness was measured at baseline using a symptom-limited maximal treadmill test. All other covariates were measured concurrently with echocardiography.

Results

Gender, body mass index, and systolic blood pressure were associated with LV mass and relative wall thickness and LA size in multivariate models. Additional correlates of LV mass/height2.7 ratio were tobacco use, resting heart rate (inverse), self-reported physical activity, gender (male higher), and age. Age was associated with LV relative wall thickness but not other measures of LV size. Additional correlates of LA diameter/height ratio were tobacco use, resting heart rate (inverse), serum glucose, and self-reported physical activity. Seven hundred ninety of 4059 subjects (19%) were classified as having low risk; black race was less likely in the low-risk group. Those with low risk had lower LV mass/height2.7 ratios (32.0 vs 34.6 g/m2.7, P < .0001), better LV relative wall thickness (0.33 vs 0.35, P < .0001), and lower LA diameter/height ratios (2.02 vs 2.08 cm/m, P < .01).

Conclusions

A low cardiovascular risk profile in young adulthood is associated with more favorable LV mass, LV relative wall thickness, and LA size. This may be one mechanism of lifestyle protection against cardiovascular morbidity and mortality.

Section snippets

Methods

Details regarding the overall design, recruitment, and overall methods of the CARDIA study have been previously published.19 The CARDIA study is a longitudinal study of acquisition of cardiovascular risk factors in young adults recruited at age 18 to 30 years. The cohort was selected from the general population to include black and white men and women, about half of whom had more than a high school education and half had less. The year 25 examination will occur in 2010 and 2011. In year 5, of

Results

The distribution of echocardiographic parameters in the total sample and stratified by sex is reported in Table 1. All of the echocardiographic parameters were smaller in women compared with men.

Blacks were less likely to have low optimal health status. For the entire group with nonoptimal health status, blood pressure was 5.3/3.9 mm Hg higher, BMI was 3.4 kg/m2 higher, treadmill duration was 3 minutes less, and self-reported physical activity was 75 exercise units less.

Univariate correlates of

Discussion

Low cardiovascular disease risk profiles (ie, optimal health status) were associated with lower LV mass, better LV relative wall thickness, and lower LA diameter in the present study. Although longitudinal population-based data on echocardiographic measures are limited, this study suggests that maintaining optimal BMI, blood pressure, nonsmoking status, and physical fitness for the first 3 to 4 decades of life minimizes adverse differences in echocardiographic measures of risk. With aging,

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    • The Coronary Artery Risk Development In Young Adults (CARDIA) Study: JACC Focus Seminar 8/8

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      Numerous investigations have documented antecedent RFs and risk markers for development of adverse left ventricular (LV) structure and function. Among those factors found to be associated with echocardiographic outcomes in CARDIA are as follows: self-identified race (18); obesity/adiposity (19–21), duration of obesity and patterns of obesity, and weight gain over time; insulin resistance and glycemia patterns as well as diabetes and duration of diabetes (22,23); nonalcoholic fatty liver disease (24); baseline and cumulative BP exposures (25), as well as long-term visit-to-visit BP variability (26); renal function (27); menopause (28); alcohol intake (29); and level of composite CVH (30,31). Using echocardiographic data from Years 5, 25, and 30, CARDIA investigators recently defined normative age-related changes (32,33).

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      2018, International Journal of Cardiology
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      Among 4059 young adults participating in the CARDIA-study, baseline RHR was inversely associated with left ventricular mass (LVM) and left atrial dimension [27]. At 25-year follow up, longitudinal increases in RHR were inversely associated with LVM, but not with relative wall thickness [28]. However, measurements of ventricular function are generally normal in trained athletes, while early signs of pathology such as impaired global longitudinal strain [29] and diastolic dysfunction can be found among patients with hypertension [30].

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      2014, JACC: Heart Failure
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      Taken together, these data suggest that diastolic dysfunction might play a significant role in predisposing subjects with low mid-life fitness to a higher risk for HFpEF at a later age. Whereas self-reported physical activity has previously been associated with higher LV mass and larger LV end-diastolic volume (25–28), there are few studies that have comprehensively addressed the association between measured fitness and echocardiographic measures of LV structure and function in middle-aged adults (29). To our knowledge, this is the first paper to examine the association between measured cardiorespiratory fitness and echocardiographic measures of both LV structure and function in a large cohort of healthy, asymptomatic, middle-aged adults not referred for exercise testing.

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    Work on this report was supported (or partially supported) by contracts University of Alabama at Birmingham, Coordinating Center, N01-HC-95095 University of Alabama at Birmingham, Field Center, N01-HC-48047 University of Minnesota, Field Center, N01-HC-48048 Northwestern University, Field Center, N01-HC-48049 Kaiser Foundation Research Institute, and N01-HC-48050 University of California, Irvine, Echocardiography Reading Center.

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