Comorbidities and Cardiometabolic Disease: Relationship With Longitudinal Changes in Diastolic Function
Matthew Nayor1, Danielle M Enserro2, Vanessa Xanthakis3
1Framingham Heart Study, Framingham, Massachusetts; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Cardiometabolic risk factors and comorbidities worsen diastolic dysfunction (DD) over time in adults. Moderate or worse DD increases the risk of cardiovascular disease (CVD) or death.
Area of Science:
- Cardiology
- Cardiovascular Research
- Heart Function Studies
Background:
- Longitudinal changes in left ventricular (LV) diastolic dysfunction (DD) and its correlates are not fully understood.
- Clinical risk factors associated with the progression of DD require further investigation.
Purpose of the Study:
- To evaluate the course, correlates, and prognosis of longitudinal changes in LV diastolic dysfunction (DD).
- To assess the impact of risk factors on DD progression and its association with cardiovascular outcomes.
Main Methods:
- Echocardiography was used to assess diastolic function in 1,740 participants from the Framingham Heart Study over a mean interval of 5.6 years.
- Participants had normal LV systolic function and no atrial fibrillation at baseline.
Main Results:
- 12% of individuals with normal-to-mild DD progressed to moderate or worse DD, more common in women and older adults.
- 20% of those with moderate or worse DD regressed to normal-to-mild DD, associated with younger age.
- Age, female sex, blood pressure, BMI, triglycerides, diabetes, and noncardiac comorbidity were associated with worsening DD.
- Moderate or worse DD was linked to a 2.14-fold increased risk of cardiovascular disease (CVD) or death.
Conclusions:
- Cardiometabolic risk factors and noncardiac comorbidities are associated with the progression of diastolic dysfunction in middle-aged to older adults.
- Moderate or worse diastolic dysfunction is a significant predictor of cardiovascular disease or death.
Objectives:
This study sought to evaluate the course, correlates, and prognosis of longitudinal changes in left ventricular (LV) diastolic dysfunction (DD) in the community-based Framingham Heart Study.
Background:
Relationships of clinical risk factors to longitudinal progression of DD are incompletely understood.
Methods:
Diastolic function was assessed by echocardiography performed at consecutive examinations (visits 1 and 2, mean interval 5.6 years) in 1,740 participants (64 ± 8 years of age at visit 1, 59% women) with normal LV systolic function and no atrial fibrillation.
Results:
Of 1,615 individuals with normal-to-mild DD at visit 1, 198 (12%) progressed to ≥ moderate DD at visit 2. Progression was more likely in women and with advancing age (p < 0.0001). Of 125 individuals with ≥ moderate DD at visit 1, 25 (20%) regressed to normal-to-mild DD by visit 2. Regression of DD was associated with younger age (p < 0.03). In stepwise regression models, age, female sex, baseline and changes in systolic blood pressure, diastolic blood pressure, body mass index, serum triglycerides, and diabetes were positively associated with worsening diastolic function (all p < 0.05). Noncardiac comorbidity tracked with progressive DD. Cardiovascular disease (CVD) or death events occurred in 44 of 1,509 participants free of CVD at visit 2, during 2.7 ± 0.6 years of post-visit 2 follow-up. Presence of ≥ moderate DD was associated with higher risk (age- and sex-adjusted hazard ratio for CVD or death: 2.14; 95% confidence interval: 1.06 to 4.32; p = 0.03).
Conclusions:
In a community-based cohort of middle-aged to older adults, cardiometabolic risk factors and noncardiac comorbidities were associated with DD progression. Moderate or worse DD was associated with higher risk of CVD or death.
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