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Clinical Research

Associations of body size and composition with subclinical cardiac dysfunction in older individuals: the cardiovascular health study

International Journal of Obesity volume 45, pages 2539–2545 (2021)Cite this article

Subjects

Abstract

Background

Focused studies in younger to middle-aged populations have demonstrated a relationship between obesity and adverse cardiac mechanics. We examined whether measures of overall and central adiposity are associated with cardiac mechanics, assessed by speckle-tracking echocardiography, in an older population without prevalent coronary heart disease or heart failure.

Methods

Body composition was measured by anthropometry, bioelectrical impedance, and dual-energy x-ray absorptiometry among participants in the Cardiovascular Health Study, a population-based cohort of adults aged 65 years or older. Systolic and diastolic cardiac mechanics were measured with speckle-tracking analysis of echocardiograms. Multi-variable adjusted linear regression models were used to investigate associations of body composition measures and cardiac mechanics.

Results

Mean age for the 3525 included participants was 72.6 years, 39% were male, and 10% were black. Mean body-mass index (BMI) was 26.3 ± 4.4 kg/m2, waist circumference (WC) was 93.2 ± 12.9 cm, and waist-to-hip ratio was 0.92 ± 0.09. In fully adjusted analyses, all adiposity measures were associated with worse LV longitudinal strain, LV early diastolic strain rate, and left atrial reservoir strain; however, associations were strongest for WC and BMI (p < 0.001). When both BMI and WC were included in the same model, only WC remained associated with each cardiac strain measure.

Conclusion

In this cross-sectional study of older adults, central obesity was most robustly associated with impaired left ventricular systolic and diastolic strain as well as left atrial strain. The adverse effects of central obesity appear to extend even into older age.

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Funding

This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants. U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood. Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Parveen K. Garg

  2. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Mary L. Biggs

  3. Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Jorge R. Kizer

  4. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Jorge R. Kizer

  5. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sanjiv J. Shah

  6. Division of Aging, Department of Medicine Brigham and Women’s Hospital, Boston, MA, USA

    Luc Djousse

  7. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth J. Mukamal

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  1. Parveen K. Garg
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Contributions

Study design: PKG, MLB, KM. Data collection: MLB, SJS. Data analysis: MLB. Manuscript draft: All authors contributed, read and approved the final manuscript. Transparency declaration: PKG (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Corresponding author

Correspondence to Parveen K. Garg.

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Competing interests

SJS has received research grants from Actelion, AstraZeneca, Corvia, Novartis, and Pfizer; and has received consulting fees from Abbott, Actelion, AstraZeneca, Amgen, Axon Therapeutics, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Cardiora, CVRx, Cytokinetics, Eisai, GSK, Ionis, Ironwood, Lilly, Merck, MyoKardia, Novartis, Novo Nordisk, Pfizer, Regeneron, Sanofi, Shifamed, Tenax, and United Therapeutics. All other authors declare no competing interests.

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Garg, P.K., Biggs, M.L., Kizer, J.R. et al. Associations of body size and composition with subclinical cardiac dysfunction in older individuals: the cardiovascular health study. Int J Obes 45, 2539–2545 (2021). https://doi.org/10.1038/s41366-021-00926-y

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