What is the Impact of Excessive Adiposity and Elevated BP on Adulthood LVH?

The adverse influence of excessive adiposity and elevated blood pressure (BP) levels on left ventricular hypertrophy (LVH) begin in childhood, according to a study published Oct. 6 in the Journal of the American College of Cardiology.

Led by principal investigator Chin-Chin Lai, MD, Department of Epidemiology, Tulane University, New Orleans, LA, the Bogalusa Heart Study was a biracial (65 percent white, 35 percent black), community-based, long-term examination of the early natural history of cardiovascular disease beginning in childhood. Between 1973 and 2010, nine cross-sectional surveys of children ages four to 18 years and 10 cross-sectional surveys of adults ages 19 to 52 years who had been previously examined as children were conducted in Bogalusa, LA. In a longitudinal cohort of 1,061 adults, age 24 to 46 years, who had been examined four or more times for body mass index (BMI) and BP starting in childhood, with a mean follow-up of 28.0 years, the area under the their statistical curve was calculated as a measure of long-term burden (total area under the their statistical curve) and trends (incremental area under the their statistical curve) of BMI and BP from childhood to adulthood. Four left ventricular (LV) geometric types were defined: normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy – all on the basis of LV mass indexed for body height and relative wall thickness. 

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The study found that higher values of BMI, as well as systolic and diastolic BP in childhood and adulthood, were all significantly associated with higher LV mass index and LVH. In addition, higher values of BMI and BP in childhood and adulthood, total area under the statistical curve, and incremental area under the statistical curve were substantially associated with eccentric hypertrophy, and concentric hypertrophy. All of these measures of BMI had a profound influence on eccentric hypertrophy, as compared to measures of BP.

The authors conclude that they “demonstrated that childhood and adulthood values and long-term cumulative burden and trends of BMI and BP are all powerful predictors of adulthood LVH and its remodeling patterns.”

“There is broad awareness that obesity rates in adults have increased dramatically (two-fold) in the past three decades,” writes Sheldon Litwin, MD, FACC, Department of Internal Medicine, Division of Cardiology, Medical University of South Carolina, in a related comment.  “Although the total prevalence of obesity remains lower in children than in adults, the rate of increase in childhood obesity has been nearly double that in adults. We should find this particularly worrisome because obese children are much more likely than are normal-weight children to become obese adults. Even more disconcerting are the observations that obese children are more likely to develop cardiovascular disease compared with adults, and that subsequent weight loss may not entirely eliminate that excess risk. As childhood obesity becomes more prevalent, we can reasonably anticipate substantial amplification of obesity-related complications in adults.”

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Hypertrophy, Left Ventricular, Prevalence, Follow-Up Studies, Body Mass Index, African Americans, Weight Loss, Cross-Sectional Studies, Pediatric Obesity, European Continental Ancestry Group, Adiposity, Blood Pressure, Obesity, African Continental Ancestry Group, United States

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