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Cardiovascular Risk Factors and Left Ventricular Geometry in Advanced Age. Ruth Teh , Ngaire Kerse , Robert Doughty, Gillian Whalley , Elizabeth Robinson. The 2011 Conference for General Practice 1 Sept 2011, The Langham Hotel, Auckland. Background.

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Cardiovascular risk factors and left ventricular geometry in advanced age

Cardiovascular Risk Factors and Left Ventricular Geometry in Advanced Age

Ruth Teh, NgaireKerse, Robert Doughty, Gillian Whalley, Elizabeth Robinson

The 2011 Conference for General Practice

1 Sept 2011, The Langham Hotel, Auckland


Background
Background

  • The heart remodels with natural ageing or pathological process.

  • In healthy adults, ageing is associated with left ventricular (LV) concentric remodelling (CR)1

  • In adults >70 years, CR is a more common LV geometric pattern than concentric or eccentric left ventricular hypertrophy (LVH)2

  • Ganau & Realdi. J Hypertens. 1995: 13(12): 1818-22

  • Lavie et al. Am J Cardiol. 2006: 98(10): 1396-9


  • In elderly men, compare to NG, CR is associated with higher 24-hour heart rate, waist-hip ratio, 2-hour glucose level and lower insulin sensitivity index3

  • In older adults (mean age 62 yrs) without clinical CVD, CR was predictive of stroke and coronary heart disease4

  • LVH confers a substantially increase risk for heart failure4

3. Sundström, Lind, Nyström, et al. Circulation. 2000;101(22):2595-600.

4. Bluemke et al. J Am Coll Cardiol. 2008;52(25):2148-55


  • Milani et al (2006) demonstrates that those with CR who convert to NG have a better prognosis than those who convert to LVH

Milani RV, Lavie CJ, Mehra MR, et al. Am J Cardiol. 2006;97(7):959-63.


  • What we know:

    • A whelm of literature has established a list risk factors associated with CVD

  • What we don’t know:

    • What is the relationship between CV risk factors and LV geometry in people of advanced age?


Objective
Objective

To explore the relationship between left ventricular (LV) geometry and cardiovascular risk factors in those living to advanced age


Method
Method

  • Cross-sectional study

  • Study sample: 33 Māori aged 75-79; 75 non-Māori aged 85 yrs

  • Recruitment: Rotorua, Whakatane & Opotiki

  • 100 had an echocardiogram

    • 30 Māori; 70 non-Māori

  • Physical assessments: Ht, Wt, waist and hip circumference, blood pressure

  • Fasting serum: glucose, lipids and 25(OH)D



Statistical analysis
Statistical analysis (LV mass ≥44g/m

  • Descriptive statistics: Socio-demographic data, medical history and clinical characteristics

  • ANOVA/Kruskal-Wallis: comparisons among multiple groups

  • p<0.05 was considered statistically significant


Results demographic
Results: (LV mass ≥44g/mDemographic

  • Gender: Men 48 (44%); Women 60 (54%)

  • Marital Status: Widowed 53%; married or partnered 38%; divorced or separated 6%; never married 3%

  • Living arrangement: Private residence 86%; retirement village 6%, low level dependency long term residential care 4% and on the marae4%

  • Education: Secondary 38%; tertiary 36%; primary 26%

  • Financial: ‘comfortable’ 86%, ‘just have enough to get along’ 11%, and ‘could not make ends meet’ 3%.


Results medical history
Results: (LV mass ≥44g/mMedical history

  • Never smoked cigarettes, n=55 (51%)

  • Dyslipidemia, n=92 (85%)

  • Hypertension, n=91 (84%)

  • Type 2 diabetes, n=22 (20%)

  • Clinically manifest CVD, n=72 (67%)


Results lv geometry
Results: (LV mass ≥44g/mLV geometry

  • 84 of 100 who had an echocardiogram were grouped into four LV geometry group


Results lv geometry anthropometry
Results: (LV mass ≥44g/mLV geometry & Anthropometry

BMI

WC

p=0.002

p=0.040

Those with a normal LV geometry had a lower BMI (23.8kg/m2) than those with abnormal LV geometry

Those with a normal LV geometry had a lower WC(89.1cm) than those with abnormal LV geometry


Results lv geometry body fat
Results: (LV mass ≥44g/mLV geometry & Body fat

Those with a normal LV geometry had a lower BF% than those with LVH

p=0.018


Results lv geometry other cvd risk factors
Results: (LV mass ≥44g/mLV geometry & other CVD risk factors

  • Not different between the four LV geometry groups

    • Systolic and diastolic BP

    • Fasting glucose

    • Lipid profiles


Discussion lv geometry and anthropometric measures
Discussion: (LV mass ≥44g/mLV geometry and anthropometric measures

5. Turkbey, McClelland , Kronmal , et al. JACC: Cardiovascular Imaging. 2010;3(3):266-74.

6. Chumlea, Schubert, Towne, et al. Journal of Nutrition, Health and Aging. 2009;13(9):821-5

7. Payne, Eleftheriou, James, et al. Heart. 2006;92(12):1784-8.

8. Lieb, Xanthakis, Sullivan, et al. Circulation. 2009;119(24):3085-92.

  • Our study: those with abnormal LV geometry had higher BMI and WC

  • The MESA5 and Fels Longitudinal Study6 found LVM is positively associated BMI and WC

  • In younger adults, increase LVM is a response to metabolic demand7.

  • In older adults, increased LVM may be related to morbid morphology of the left ventricle (consequence of CVD risk factors) but there is also the effect of habitual physical activity on LVM and perhaps increasing LVM with ageing8 is part of the compensatory mechanism.


Discussion lv geometry and body fat
Discussion: (LV mass ≥44g/mLV geometry and Body Fat

  • Our study: those LVH had a higher BF%

  • Adipocytesproduce significant amount of TNF- and IL-69; both cytokines have been implicated for CHF10

  • However, we cannot conclude increased BF% adversely affect LV geometry; BF% does not distinguish between visceral and peripheral fat

  • We speculate that cytokines produced by adipocytes mediate the relationship between BMI, WC and LV geometry observed in previous5,6 and current study.

9. Fantuzzi G. J Allergy Clin Immunol. 2005;115:911-9.

10. Kalogeropoulos, Georgiopoulou, Psaty, et al. J Am Coll Cardiol. 2010;55(19):2129-37.


Discussion lv geometry and 25 oh d
Discussion: (LV mass ≥44g/mLV geometry and 25(OH)D

  • Our study: 25(OH)D levels lowest in those with CR

  • The Hoorn Study found LV geometry was not associated with 25(OH)D11 but found prevalence of diastolic dysfunction was significantly higher in the first 25(OH)D quartile than the fourth quartile but this association was attenuated after adjustments for age, sex and other CVD risk factors

  • We do not know why those with CR had a lower 25(OH)D than those with NG. We speculate that this relationship is confounded by the association between health status and physical activity; sun exposure is the major source of vitamin D in older adults in New Zealand.

11. Pilz, Henry, Snijder, et al. J Endocrinol Invest. 2010;33(9):612-7.


Study limitations
Study Limitations (LV mass ≥44g/m

  • Cross-sectional analysis

  • Small sample size

  • Healthy survivor cohort effect

Study Strength

  • Comprehensive physical assessment inclusive of an echocardiogram on 100 people living to advanced age


Conclusions 1
Conclusions (1) (LV mass ≥44g/m

CVD is prevalent in advanced age

Half of the sample have a normal LV geometry

Body composition is related to LV geometry

Serum vitamin D differs between LV geometry groups and may be implicated in cardiac remodelling

Blood pressure was not associated with LV geometry


Conclusion 2
Conclusion (2) (LV mass ≥44g/m

  • Findings from this study extend the limited evidence on the relationship between LV geometry and CVD risk factors

  • Owing to the small sample size, findings from this study need to be interpreted cautiously

  • The Life and Living to Advanced Age, a Cohort Study in New Zealand (LILACS NZ) is currently underway to confirm findings from this study


Acknowledgements
Acknowledgements (LV mass ≥44g/m

  • Study participants

  • Community organisations: He Korowai Oranga Rotorua; Māori Health Services, Whakatāne Hospital; Whakatohea Iwi Social and Health Services; Rotorua General Practice Group;

  • The Kaitiaki Advisory Group, Ngā Pae O Te Māramatanga

  • Sonographer: Helen Walsh

  • Funders: HRC, National Heart Foundation


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