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Early life and adulthood risk factors for middle age P-wave prolongation and left atrial enlargement

Tiia Istolahti1,2, Leo-Pekka Lyytikäinen1,2,3, Heini Huhtala4

  • 1Finnish Cardiovascular Research Center, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.

European Journal of Preventive Cardiology
|July 24, 2026
PubMed

Insights

Excess body mass index (BMI) from childhood to adulthood significantly impacts atrial remodeling. Maintaining a healthy weight throughout life is crucial for preventing atrial cardiomyopathy and related health issues.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Public Health

Background:

  • P-wave prolongation and left atrial (LA) enlargement are established markers of atrial cardiomyopathy.
  • These cardiac abnormalities are associated with increased risks of atrial fibrillation, stroke, and mortality.
  • Early life cardiovascular risk factors may influence long-term atrial structure and function.

Purpose of the Study:

  • To investigate the association between cumulative cardiovascular risk factors in early life and P-wave duration and LA size in middle age.
  • To identify key modifiable determinants of atrial remodeling in a young adult cohort.
  • To understand the long-term impact of early life adiposity on cardiac health.

Main Methods:

  • Analysis of data from the prospective, ongoing Cardiovascular Risk in Young Finns Study (initiated in 1980).
  • Assessment of traditional cardiovascular risk factors repeatedly between ages 6-24 years (1980-2001).
  • Transthoracic echocardiography and electrocardiography performed in 2011; logistic regression used for association analysis.

Main Results:

  • Cumulative early life Body Mass Index (BMI) burden was significantly associated with longer P-wave duration, larger LA diameter, and greater LA volume.
  • Each standard deviation increase in early life BMI burden correlated with longer P-wave duration (1.85 ms), larger LA diameter (0.11 cm), and greater LA volume (3.31 mL).
  • Persistent or adult-onset high BMI was linked to larger LA size; male sex and older age were also associated with P-wave and LA parameters.

Conclusions:

  • Excessive BMI from childhood through adulthood is a primary determinant of atrial remodeling observed in middle age.
  • These findings emphasize the lasting consequences of early-life adiposity on cardiovascular health.
  • Lifelong weight management is critical for preventing atrial cardiomyopathy and its associated clinical sequelae.
Abstract

Keywords:
Cardiovascular risk factorsEchocardiographyElectrocardiographyLeft atrium

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