Joint influences of obesity, diabetes, and hypertension on indices of ventricular remodeling: Findings from the community-based Framingham Heart Study

Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated. We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% wome...

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Published in:PloS one Vol. 15; no. 12; p. e0243199
Main Authors: von Jeinsen, Beatrice, Vasan, Ramachandran S., McManus, David D., Mitchell, Gary F., Cheng, Susan, Xanthakis, Vanessa
Format: Journal Article
Language:English
Published: United States Public Library of Science 10.12.2020
Public Library of Science (PLoS)
Subjects:
Biology and Life Sciences
Blood pressure
Body mass
Body Mass Index
Body size
Body weight
Cardiomyopathy
Cardiovascular diseases
Clusters
Congestive heart failure
Coronary artery disease
Diabetes
Diabetes Complications - physiopathology
Diabetes mellitus
Echocardiography
Epidemiology
Evaluation
Female
Flow velocity
Geometry
Health care
Health risk assessment
Heart failure
Humans
Hypertension
Hypertension - complications
Hypertension - physiopathology
Longitudinal Studies
Male
Medicine and Health Sciences
Metabolism
Methods
Middle Aged
Obesity
Obesity - complications
Obesity - physiopathology
Overweight
Physiological aspects
Preventive medicine
Public health
Statistical analysis
Statistical models
Test reliability
Ventricle
Ventricular Remodeling
United States
United States > US
Massachusetts
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Obesity, hypertension, and diabetes are independently associated with cardiac remodeling and frequently co-cluster. The conjoint and separate influences of these conditions on cardiac remodeling have not been investigated. We evaluated 5,741 Framingham Study participants (mean age 50 years, 55% women) who underwent echocardiographic measurements of left ventricular (LV) mass (LVM), LV ejection fraction (LVEF), global longitudinal strain (GLS), mitral E/e', left atrial end-systolic (peak) dimension (LASD) and emptying fraction (LAEF). We used multivariable generalized linear models to estimate the adjusted-least square means of these measures according to cross-classified categories of body mass index (BMI; normal, overweight and obese), hypertension (yes/no), and diabetes (yes/no). We observed statistically significant interactions of BMI category, hypertension, and diabetes with LVM, LVEF, GLS, and LAEF (p for all 3-way interactions <0.01). Overweight and obesity (compared to normal BMI), hypertension, and diabetes status were individually and conjointly associated with higher LVM and worse GLS (p<0.01 for all). We observed an increase of 34% for LVM and of 9% for GLS between individuals with a normal BMI and without hypertension or diabetes compared to obese individuals with hypertension and diabetes. Presence of hypertension was associated with higher LVEF, whereas people with diabetes had lower LVEF. Obesity, hypertension, and diabetes interact synergistically to influence cardiac remodeling. These findings may explain the markedly heightened risk of heart failure and cardiovascular disease when these factors co-cluster.
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Competing Interests: Susan Cheng has received consulting fees from Zogenix for work unrelated to this manuscript. Gary F. Mitchell has the following disclosures: a) grants: NIH, Novartis (both significant); b) consulting: Novartis, Servier, Merck, Bayer (all significant); and c) ownership: Cardiovascular Engineering, Inc. (significant). These affiliations do not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0243199