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.
Similar content being viewed by others
References
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation. 2014;141:e139–596.
Savji N, Meijers WC, Bartz TM, Bhambhani V, Cushman M, Nayor M, et al. The association of obesity and cardiometabolic traits with incident HFpEF and HFrEF. JACC Heart Fail. 2018;6:701–9.
Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality. Circulation. 2016;133:639–49.
Loehr LR, Rosamond WD, Poole C, McNeill AM, Chang PP, Folsom AR, et al. Association of multiple anthropometrics of overweight and obesity with incident heart failure: The Atherosclerosis Risk in Communities study. Circ Heart Fail. 2009;2:18–24.
de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. 2007;28:850–6.
Hu G, Jousilahti P, Antikainen R, Katzmarzyk PT, Tuomilehto J. Joint effects of physical activity, body mass index, waist circumference, and waist-to-hip ratio on the risk of heart failure. Circulation. 2010;121:237–44.
Wang YC, Liang CS, Gopal DM, Ayalon N, Donohue C, Santhanakrishnan R, et al. Preclinical systolic and diastolic dysfunctions in metabolically healthy and unhealthy obese individuals. Circ Heart Fail. 2015;8:897–904.
Aurigemma GP, de Simone G, Fitzgibbons TP. Cardiac remodeling in obesity. Circ Cardiovasc Imaging. 2013;6:142–52.
Edvardsen T, Gerber BL, Garot J, Bluemke DA, Lima JA, Smiseth OA. Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Circulation. 2002;106:50–56.
Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol. 2006;47:789–93.
Gorcsan J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. 2011;58:1401–13.
Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: Importance of left atrial strain. Circ Cardiovasc Imaging. 2016;9:e003754.
Cheng S, McCabe EL, Larson MG, Merz AA, Osypiuk E, Lehman BT, et al. Distinct aspects of left ventricular mechanical function are differentially associated with cardiovascular outcomes and all-cause mortality in the community. J Am Heart Assoc. 2015;4:e002071.
Crendal E, Walther G, Vinet A, Dutheil F, Naughton G, Lesourd B, et al. Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden. Obesity. 2013;21:E679–86.
Kishi S, Armstrong AC, Gidding SS, Colangelo LA, Venkatesh BA, Jacobs DR, et al. Association of obesity in early adulthood and middle age with incipient left ventricular dysfunction and structural remodeling: The CARDIA study. JACC Heart Fail. 2014;2:500–8.
Selvaraj S, Martinez EE, Aguilar FG, Kim KA, Peng J, Sha J, et al. Association of central adiposity with adverse cardiac mechanics: Findings from the Hypertension Genetic Epidemiology Network Study. Circ Cardiovasc Imaging. 2016;9:e004396.
Russo C, Sera F, ** Z, Palmieri V, Homma S, Rundek T, et al. Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: a population-based cohort study. Eur J Heart Fail. 2016;18:537–44.
Ho JE, McCabe EL, Wang TJ, Larson MG, Levy D, Tsao C, et al. Cardiometabolic traits and systolic mechanics in the community. Circ Heart Fail. 2017;10:e003536.
Blomstrand P, Sjoblom P, Nilsson M, Wijkman M, Engvall M, Lanne T, et al. Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain. Cardiovasc Diabetol. 2018;17:113.
Burroughs Peña M, Swett K, Schneiderman N, Spevack DM, Ponce SG, Talavera GA, et al. Cardiac structure and function with and without metabolic syndrome: The Echocardiographic Study of Latinos (Echo-SOL). BMJ Open Diab Res Care. 2018;6:e000484.
Chirinos JA, Sardana M, Satija V, Gillebert TC, De Buyzere ML, Chahwala J, et al. Effect of obesity on left atrial strain in persons aged 35-55 years (The Asklepios Study). Am J Cardiol. 2019;123:854–61.
Huffman MD, Berry JD, Ning H, Dyer AR, Garside DB, Cai X, et al. Lifetime risk for heart failure among White and Black Americans: cardiovascular lifetime risk pooling project. J Am Coll Cardiol. 2013;61:1510–7.
Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018;391:572–80.
Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–215.
Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263–76.
Gardin JM, Wong ND, Bommer W, Klopfenstein HS, Smith V-E, Tabatznik B, et al. Echocardiographic design of a multi-center investigation of free-living elderly subjects: The Cardiovascular Health Study. J Am Soc Echocardiogr. 1992;5:63–72.
Aguilar FG, Selvaraj S, Martinez EE, Katz DH, Beussink L, Kim KY, et al. Archeological echocardiography: digitization and speckle tracking analysis of archival echocardiograms in the hypergen study. Echocardiography. 2016;33:386–97.
Djousse L, Bartz TM, Ix JH, Zieman SJ, Delaney JA, Mukamal KJ, et al. Adiposity and incident heart failure in older adults: the cardiovascular health study. Obesity. 2012;20:1936–41.
Deurenberg P, van der Kooy K, Hautvast JG. The assessment of the body composition in the elderly by densitometry, anthropometry and bioelectrical impedance. Basic Life Sci. 1990;55:391–3.
Kern LM, Powe NR, Levine MA, Fitzpatrick AL, Harris TB, Robbins J, et al. Association between screening for osteoporosis and the incidence of hip fracture. Ann Intern Med. 2005;142:173–81.
Srikanthan P, Horwich TB, Tseng CH. Relation of muscle mass and fat mass to cardiovascular disease mortality. Am J Cardiol. 2016;117:1355–60.
Psaty BM, Lee M, Savage PJ, Rutan GH, German PS, Lyles M. Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group. J Clin Epidemiol. 1992;45:683–92.
Ives DG, Fitzpatrick AL, Bild DE, Psaty BM, Kuller LH, Crowley PM. Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study. Ann Epidemiol. 1995;5:278–85.
Bendiab NS, Meziane-Tani A, Ouabdesselam S, Methia N, Latreche S, Henaoui L, et al. Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction. Eur J Prev Cardiol. 2017;24:1463–72.
Dugo C, Rigolli M, Rossi A, Whalley GA. Assessment and impact of diastolic function by echocardiography in elderly patients. J Geriatr Cardiol. 2016;13:252–60.
Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J, et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010;31:737–46.
Coutinho T, Goel K, de Corrêa SD, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of “normal weight central obesity”. J Am Coll Cardiol. 2013;61:553–60.
Coutinho T, Goel K, De Corrêa SD, Kragelund C, Kanaya AM, Zeller M, et al. Central obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol. 2011;57:1877–86.
Cavalera M, Wang J, Frangogiannis NG. Obesity, metabolic dysfunction, and cardiac fibrosis: pathophysiological pathways, molecular mechanisms, and therapeutic opportunities. Transl Res. 2014;164:323–35.
Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28:1039–49.
Badimon L, Romero JC, Cubedo J, Borrell-Pagès M. Circulating biomarkers. Thromb Res. 2012;130:S12–5.
Abel ED, Sweeney G. Modulation of the cardiovascular system by leptin. Biochimie. 2012;94:2097–103.
Park M, Sweeney G. Direct effects of adipokines on the heart: focus on adiponectin. Heart Fail Rev. 2013;18:631–44.
Karas MG, Benkeser D, Arnold AM, Bartz TM, Djousse L, Mukamal KJ, et al. Relations of plasma total and high-molecular-weight adiponectin to new-onset heart failure in adults >65 years of age (from the Cardiovascular Health study). Am J Cardiol. 2014;113:328–34.
Chirinos JA, Rietzschel ER, De Buyzere ML, De Bacquer D, Gillebert TC, Gupta AK, et al. Arterial load and ventricular-arterial coupling: physiologic relations with body size and effect of obesity. Hypertension. 2009;54:558–66.
Mahabadi AA, Lehmann N, Kalsch H, Bauer M, Dykun I, Kara K, et al. Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: the Heinz Nixdorf Recall Study. Eur Heart J Cardiovasc Imaging. 2014;15:863–9.
Ybarra J, Resmini E, Planas F, Navarro-Lopez F, Webb S, Pou JM, et al. Relationship between adiponectin and left atrium size in uncomplicated obese patients: adiponectin, a link between fat and heart. Obes Surg. 2009;19:1324–32.
Barbier P, Solomon SB, Schiller NB, Glantz SA. Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation. 1999;100:427–36.
Patel RB, Delaney JA, Hu M, Patel H, Cheng J, Gottdiener J, et al. Characterization of cardiac mechanics and incident atrial fibrillation in participants of the Cardiovascular Health Study. JCI Insight. 2020;5:e141656.
Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881–7.
Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61:646–53.
Dagenais GR, Yi Q, Mann JF, Bosch J, Pogue J, Yusuf S. Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease. Am Heart J. 2005;149:54–60.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.
Lemieux I, Pascot A, Prud’homme D, Alméras N, Bogaty P, Nadeau A, et al. Elevated C-reactive protein: another component of the atherothrombotic profile of abdominal obesity. Arterioscler Thromb Vasc Biol. 2001;, 21:961–7.
Borlaug BA, Redfield MM, Melenovsky V, Kane GC, Karon BL, Jacobsen SJ, et al. Longitudinal changes in left ventricular stiffness: a community-based study. Circ Heart Fail. 2013;6:944–52.
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.
Author information
Authors and Affiliations
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
Ethics declarations
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.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41366-021-00926-y
- Springer Nature Limited
This article is cited by
-
Fat Mass is Associated with Subclinical Left Ventricular Systolic Dysfunction in Patients with Type 2 Diabetes Mellitus Without Established Cardiovascular Diseases
Diabetes Therapy (2023)
-
Glucose dysregulation and subclinical cardiac dysfunction in older adults: The Cardiovascular Health Study
Cardiovascular Diabetology (2022)