Adverse effects of adiposity, elevated BP on left ventricular hypertrophy start in childhood

New data from the Bogalusa Heart Study demonstrate that excessive adiposity and elevated BP during childhood was linked to development of left ventricular hypertrophy later in life.

Researchers evaluated data from 1,061 adults aged 24 to 46 years (65% white) who were enrolled in the longitudinal, community-based Bogalusa Heart Study, a biracial assessment of the early natural history of CVD. Participants underwent at least four assessments of BP and BMI starting in childhood, and they were followed for an average of 28 years.

All participants received LV dimension assessment via echocardiography on at least four occasions during follow-up. LV mass and relative wall thickness also were determined, and patients were classified according to LV geometry patterns: normal geometry, concentric remodeling, defined as increased relative wall thickness without LV hypertrophy; eccentric hypertrophy, defined as normal wall thickness with LV hypertrophy; and concentric hypertrophy, defined as increased wall thickness with LV hypertrophy.

Differences reported

Area under the curve (AUC) analysis indicated significant differences in total and incremental values for BMI and systolic and diastolic BP according to race and sex in the majority of cases. No difference was observed in total AUC for BMI according to sex among black participants or according to race among male participants.

LV mass was significantly higher among black participants compared with white participants, and among males compared with females. LV mass index also was significantly higher among black participants of both sexes compared with white participants, and among white males compared with white females.

Analysis of LV geometric patterns according to race indicated a significantly greater prevalence of eccentric hypertrophy (17.8% vs. 8.95%; P<.001) and concentric hypertrophy (9.1% vs. 3.6%; P<.001) among black participants compared with white participants. The data revealed no significant difference in the incidence of concentric remodeling.

Linear and logistic regression analyses indicated significant associations between LV mass index and hypertrophy at adulthood and both BMI and systolic BP. BMI and systolic BP during childhood and adulthood, in addition to total and incremental AUC values for both, were associated with eccentric and concentric hypertrophy; the same trend was not observed with concentric remodeling. The researchers also noted that the link between BMI and eccentric hypertrophy was stronger than the link between systolic BP and eccentric hypertrophy.

“These results support the notions that the adverse long-term influence of BMI and BP levels on the development of [LV hypertrophy] begins in childhood, and that the dual burden of excessive adiposity and elevated BP affects LV enlargement cumulatively during the lifetime,” Chin-Chih Lai, MD, from the department of epidemiology at Tulane University and the department of cardiology at Peking Union Medical College Hospital, Beijing, and colleagues concluded. “These findings underscore the importance of undertaking preventive strategies for CVD early in life by controlling body weight and BP levels.”

Bogalusa one of four studies

In a related editorial, Sheldon E. Litwin, MD, from the cardiology division at Medical University of South Carolina in Charleston, noted that the Bogalusa Heart Study is one of four large-scale longitudinal studies, in collaboration as the International Childhood Cardiovascular Cohort Consortium, assessing the CV impact of childhood obesity.

“Although we eagerly await the insights that will emerge from the collaboration, we cannot forestall embarking on the monumental effort that will be required to find methods to control, or better yet, prevent the growing crisis of childhood obesity,” Litwin wrote.

For more information:

Lai CC. J Am Coll Cardiol. 2014;64:1580-1587.

Litwin SE. J Am Coll Cardiol. 2014;64:1588-1590.

Disclosure: The researchers and Litwin report no relevant financial disclosures.