Association of Obesity in Early Adulthood and Middle Age With Incipient Left Ventricular Dysfunction and Structural Remodeling: The CARDIA Study (Coronary Artery Risk Development in Young Adults)

Study Questions:

Is there a relationship between body mass index (BMI) and subsequent changes in left ventricular (LV) structure and function?


The CARDIA (Coronary Artery Risk Development in Young Adult) study enrolled white and black adults, ages 18-30 years, in 1985 to 1986 (year 0). At year 25, cardiac function was assessed by conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). The 25-year change in BMI (classified as low [<27 kg/m2] and high [≥27 kg/m2]) was categorized into four groups (Low-Low, High-Low, Low-High, and High-High). Multiple linear regression was used to quantify the association between categorical changes in BMI (using Low-Low as reference) with LV structural and functional parameters obtained in middle age, adjusting for baseline and 25-year change in risk factors.


In 3,265 participants included at year 0, the mean BMI was 24.4 kg/m2. Change in BMI adjusted for risk factors was directly associated with incipient myocardial systolic dysfunction assessed by STE (High-High: β-coefficient = 0.67; Low-High: β-coefficient = 0.35 for longitudinal peak systolic strain), and diastolic dysfunction assessed by TDI (High-High: β-coefficient = –0.74; Low-High: β-coefficient = –0.45 for e’) and STE (High-High: β-coefficient = –0.06 for circumferential early diastolic strain rate). Greater BMI was also significantly associated with increased LV mass/height (High-High: β-coefficient = 26.11; Low-High: β-coefficient = 11.87).


Longstanding obesity from young adulthood to middle age is associated with impaired LV systolic and diastolic function assessed by conventional echocardiography, tissue Doppler imaging, and speckle tracking echo in a large biracial cohort of adults ages 43-55 years.


Longstanding obesity is known to be associated with cardiac dysfunction and clinical heart failure. These data from the CARDIA study demonstrate that greater BMI in early adulthood is associated with LV hypertrophy, LV dilation, but preserved LV ejection fraction; and that greater BMI during young adulthood and middle age is associated with reduced LV systolic and diastolic function assessed by myocardial deformation. This study is the first to demonstrate the significant structural and functional effects associated with obesity on the heart in early adulthood and middle age in an otherwise healthy population.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Body Mass Index, Middle Aged, Heart Failure, Risk Factors, Obesity, Hypertrophy, Ventricular Dysfunction, Left, Echocardiography

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