Association of early adult modifiable cardiovascular risk factors with left atrial size over a 20-year follow-up period: the CARDIA study

Armstrong, Anderson C.; Gidding, Samuel S.; Colangelo, Laura A.; Kishi, Satoru; Liu, Kiang; Sidney, Stephen; Konety, Suma; Lewis, Cora E.; Correia, Luís Cláudio Lemos; Lima, João A.C.

doi:10.1136/bmjopen-2013-004001

Cited by 31 publications

(23 citation statements)

References 34 publications

(29 reference statements)

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“…Assessments of risk factor variables in the CARDIA Study have been previously described [22, 27]. Briefly, the use of anti-hypertensive medication and smoking status (current smoker, former smoker and never smoker) were self-reported, assessed using validated questionnaires.…”

Section: Methodsmentioning

confidence: 99%

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

Nwabuo

Moreira

Vasconcellos

et al. 2017

Journal of the American Society of Echocardiography

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BACKGROUND The human aorta dilates with advancing age. However, the association between progressive aortic dilation with aging and cardiac remodeling has not been established in studies of community-dwelling adults. We hypothesized that there would be a relationship between aortic size increase over the early adult lifespan with left ventricular (LV) structural remodeling and subclinical LV dysfunction in middle age, even in the absence of overt cardiovascular and valvular disease. METHODS Included were Coronary Artery Risk Development in Young Adults (CARDIA) study participants (n=2933) aged 23–35 years with available transthoracic echocardiography measurements during 20-years of follow-up. Multivariable linear regression models assessed sex-specific associations between 20-year change in aortic root diameter with LV structure and function. RESULTS Larger aortic root diameter at 20-year follow-up was associated with greater LV mass (2.77g/mm versus 2.18/mm, in men and women respectively, p<0.001). In longitudinal analyses, increase in aortic root diameter over 20-year follow up was associated with a greater 20-year increase in LV mass and LV Mass to LV end diastolic volume ratio in both sexes. In women but not in men, increased aortic root diameter over 20-years was associated with increased left atrial dimension, impaired E/E′ and impaired early diastolic longitudinal and circumferential strain rates assessed by speckle tracking echocardiography. CONCLUSIONS Progressive increase in aortic root diameter from early adulthood to middle age was associated with increased LV mass and LV concentric remodeling in both sexes and impaired diastolic function predominantly in women.

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Section: Methodsmentioning

confidence: 99%

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

Nwabuo

Moreira

Vasconcellos

et al. 2017

Journal of the American Society of Echocardiography

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“…The recently published CARDIA (Coronary Artery Risk Development in Young Adults) study investigated the influence of modifiable cardiovascular risk factors on LA size in 2903 young adults (age 23–35 years) over a 20‐year follow‐up period . After a 5‐year period, investigators showed that diabetes was not associated with unindexed LA diameter and LA diameter indexed for body surface area or height.…”

Section: Left Atrial Structure and Function In Diabetesmentioning

confidence: 99%

The Influence of Type 2 Diabetes on Left Atrial Remodeling

Tadić

Cuspidi

2014

Clinical Cardiology

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The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.

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“…Furthermore, increases in BMI and BP are main determinants of cardiac remodeling over decades of adulthood (21,22). In fact, more severe obesity appears to be implicated with hospitalization for HF in patients with type 1 diabetes (23).…”

Section: Discussionmentioning

confidence: 99%

Association of Cardiovascular Risk Factors and Myocardial Fibrosis With Early Cardiac Dysfunction in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

et al. 2016

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OBJECTIVEWe investigated the association of cardiovascular risk factors and myocardial fibrosis with early cardiac dysfunction in type 1 diabetes.RESEARCH DESIGN AND METHODSParticipants with type 1 diabetes aged 13–39 years without a known history of cardiovascular disease (CVD) (n = 1,441) were recruited into the Diabetes Control and Complications Trial (1983–1993) and subsequently followed in the Epidemiology of Diabetes Interventions and Complications study (1994 to present). Seven hundred fourteen participants underwent cardiac magnetic resonance (CMR) imaging (2007–2009) with late gadolinium enhancement sequences to assess ischemic and nonischemic scars and tagging sequences to evaluate circumferential strain. CMR-derived T1 mapping also was used to assess interstitial fibrosis. The influence of cardiovascular risk factors and myocardial scar on circumferential strain was assessed using linear regression.RESULTSCircumferential dysfunction was consistently associated with older age, male sex, smoking history, obesity, higher blood pressure, lower HDL cholesterol, and higher mean HbA1c. Participants with nonischemic scars (n = 16) had the worst circumferential function compared with those without scars (β ± SE 1.32 ± 0.60; P = 0.03). In sex-adjusted models, the correlation between T1 times and circumferential strain was not significant. In the fully adjusted models, a trend toward circumferential dysfunction in participants with nonischemic scars was found. Left ventricular ejection fraction was not associated with risk factors but was significantly lower if a myocardial scar was present.CONCLUSIONSTraditional CVD risk factors and elevated HbA1c levels are major factors related to early cardiac dysfunction in type 1 diabetes. Nonischemic myocardial scar, possibly as a marker of chronic exposure to known risk factors, may predict early cardiac dysfunction mediated by diffuse myocardial fibrosis as seen in diabetic cardiomyopathy.

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Association of early adult modifiable cardiovascular risk factors with left atrial size over a 20-year follow-up period: the CARDIA study

Cited by 31 publications

References 34 publications

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

Association of Aortic Root Dilation from Early Adulthood to Middle Age with Cardiac Structure and Function: The CARDIA Study

The Influence of Type 2 Diabetes on Left Atrial Remodeling

Association of Cardiovascular Risk Factors and Myocardial Fibrosis With Early Cardiac Dysfunction in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

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