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Sex-Dependent Effects of Body Fat on Cardiac Function and Outcomes in Community-Dwelling Older Adults
Haowen Jiang1, Jie Jun Wong1, Glades H M Tan1
1Department of Cardiology, National Heart Centre Singapore, Singapore.
Background:
Among older adults, sex hormones may exert differential effects on body fat and cardiac health.
Objectives:
The authors aimed to study the effects of sex on body fat composition and aging-related diastolic function, as well as their longitudinal changes.
Methods:
Community-dwelling older adults without cardiovascular disease underwent prospective baseline same-day anthropometry for body fat mass (BFM), percentage body fat (PBF), and waist hip ratio (WHR) quantification by bioimpedance and transthoracic Doppler echocardiography, with measurements repeated at 5 years. Study outcomes included diastolic grade, ratio of early to late diastolic inflow velocities (E/A), ratio of mitral early diastolic inflow velocity to the average of septal and lateral early diastolic annular tissue velocities (E/e') ratios, left ventricle mass index, left atrial volume index and clinical outcomes. Correlations between baseline or interval changes (Δ) of WHR, BFM and PBF with follow-up or Δ values of outcomes were analyzed, with multivariable linear regression model adjustments for significant variables.
Results:
Among 409 older adults (mean age 61 ± 12.7 years, 214 women) with median follow-up of 4.9 (4.5, 5.2) years, baseline BFM predicted echocardiographic diastolic dysfunction at follow-up in women (OR: 1.059; 95% CI: 1.051-1.115; P = 0.002). Baseline PBF was associated with ΔE/A (β: 0.010; P = 0.028) among women and ΔE/e' (β: -0.069; P = 0.020) among men, with significant interactions between sex and PBF in predicting ΔE/A (P < 0.05). ΔBFM (β: -0.007; P = 0.05) and ΔPBF (β: -0.005; P = 0.047) were associated with ΔE/A independent of baseline BFM/PBF among women. Baseline (HR: 1.141; 95% CI: 1.027-1.158; P = 0.005) and changes in WHR (HR: 0.857; 95% CI: 0.790-0.931; P < 0.001) predicted cardiovascular outcomes among women.
Conclusions:
Baseline and interval increase in fat quantity via bioimpedance defined differential trajectories of longitudinal cardiac functional deteriorations between sexes.
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