Impact of Long-Term Burden of Excessive Adiposity and Elevated Blood Pressure From Childhood on Adulthood Left Ventricular Remodeling Patterns: The Bogalusa Heart Study

Study Questions:

What is the long-term burden of excessive adiposity and elevated blood pressure (BP) during childhood into adulthood?

Methods:

Data from the Bogalusa Heart Study were used for this analysis. The Bogalusa Heart Study is a biracial (65% white, 35% black) community-based cohort, followed over time to examine the early natural history of cardiovascular disease (CVD). Between 1973 and 2010, nine cross-sectional surveys of children, ages 4-18 years, and 10 cross-sectional surveys of adults, ages 19-52 years, who had been previously examined as children, were conducted in Bogalusa, LA. In this longitudinal cohort, 1,194 adults had echocardiographic left ventricular (LV) dimensions in adulthood, captured from 2004 to 2010, and repeated measurements of CV risk factors from childhood to adulthood. Subjects were excluded who had not been examined for CV risk factors at least 4 times, and also excluded were hypertensive patients who were under treatment. The mean follow-up period was 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of body mass index (BMI) and BP from childhood to adulthood. Four 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.

Results:

A total of 1,061 adults between the ages of 24 and 46 years and who had been followed for an average of 28 years were included in this analysis. During childhood, in general, sex and race differences in study variables were not significant. During adulthood, BMI differed by sex in black participants (men < women), and black women had significantly higher BMI than did white women. In adulthood, systolic BP and diastolic BP had significant race (black > white) and sex (men > women) differences. Higher values of BMI and systolic and diastolic BP in childhood and adulthood, as well as total AUC and incremental AUC, were all significantly associated with higher LV mass index and LV hypertrophy, adjusted for race, sex, and age. Higher values of BMI and BP in childhood and adulthood, total AUC, and incremental AUC were significantly associated with eccentric hypertrophy and concentric hypertrophy, but not with concentric remodeling. BMI had a consistently and significantly greater influence on eccentric hypertrophy than did measures of BP.

Conclusions:

The investigators concluded that these findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LV hypertrophy begins in childhood.

Perspective:

These data support the need for interventions that reduce childhood overweight and obesity in order to reduce the long-term effects, which include elevated BP.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement

Keywords: Child, Body Height, Hypertrophy, Left Ventricular, Adult, Body Mass Index, Overweight, European Continental Ancestry Group, Ventricular Remodeling, Adiposity, Risk Factors, Blood Pressure, Cost of Illness


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