Transcript Cardiovascular Risk Factors and Echocardiographic

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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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
0.42
>0.42
Relative wall
thickness
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The heart remodels with natural ageing or
pathological process.
Concentric
remodelling
(CR)
Concentric
hypertrophy
(CH)
Normal
geometry
(NG)
Eccentric
hypertrophy
(EH)
Normal LVM
LVH
1. Ganau & Realdi. J Hypertens. 1995: 13(12): 1818-22
2. Lavie et al. Am J Cardiol. 2006: 98(10): 1396-9
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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
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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.
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What we know:
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A whelm of literature has established a list
risk factors associated with CVD
What we don’t know:
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What is the relationship between CV risk
factors and LV geometry in people of
advanced age?
Objective
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To explore the relationship between left
ventricular (LV) geometry and
cardiovascular risk factors in those living
to advanced age
Method
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Cross-sectional study
Study sample: 33 Māori aged 75-79; 75 nonMāori aged 85 yrs
Recruitment: Rotorua, Whakatane & Opotiki
100 had an echocardiogram
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30 Māori; 70 non-Māori
Physical assessments: Ht, Wt, waist and hip
circumference, blood pressure
Fasting serum: glucose, lipids and 25(OH)D
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LV geometry was categorised into four groups based on
LVH (LV mass ≥44g/m2.7 for women or ≥48g/m2.7 for
men) and relative wall thickness (RWT):
>0.42
Concentric
hypertrophy
(CH)
0.42
Relative wall thickness
Concentric
remodelling
(CR)
Normal
geometry
(NG)
Eccentric
hypertrophy
(EH)
Normal LVM
LVH
Statistical analysis
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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:
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Demographic
Women 60 (54%)
Marital Status: Widowed 53%; married or partnered 38%;
Gender: Men 48 (44%);
divorced or separated 6%; never married 3%
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Living arrangement: Private residence 86%; retirement
village 6%, low level dependency long term residential care 4% and
on the marae 4%
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Secondary 38%; tertiary 36%; primary 26%
‘comfortable’ 86%, ‘just have enough to get
Education:
Financial:
along’ 11%, and ‘could not make ends meet’ 3%.
Results:
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Medical 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:
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LV geometry
84 of 100 who had an echocardiogram were
grouped into four LV geometry group
>0.42
Concentric
remodelling
(CR)
Concentric
hypertrophy
(CH)
0.42
CH, 10,
12%
CR, 12,
14%
NG, 40,
48%
Relative wall thickness
EH, 22,
26%
Normal
geometry
(NG)
Eccentric
hypertrophy
(EH)
Normal LVM
LVH
Results:
LV geometry & Anthropometry
BMI
p=0.002
Those with a normal LV geometry had
a lower BMI (23.8kg/m2) than those
with abnormal LV geometry
WC
p=0.040
Those with a normal LV geometry had
a lower WC(89.1cm) than those with
abnormal LV geometry
Results:
LV 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
 Not
different between the four LV
geometry groups
Systolic and diastolic BP
 Fasting glucose
 Lipid profiles
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Discussion:
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LV geometry and
anthropometric measures
Our study: those with abnormal LV geometry had higher BMI and WC
5
6
The MESA and Fels Longitudinal Study found LVM is positively
associated BMI and WC
7
In younger adults, increase LVM is a response to metabolic demand .
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
8
with ageing is part of the compensatory mechanism.
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.
Discussion:
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LV geometry and Body Fat
Our study: those LVH had a higher BF%
9
Adipocytes produce significant amount of TNF- and IL-6 ; both
10
cytokines have been implicated for CHF
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
5,6
relationship between BMI, WC and LV geometry observed in previous
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:
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LV geometry and 25(OH)D
Our study: 25(OH)D levels lowest in those with CR
11
The Hoorn Study found LV geometry was not associated with 25(OH)D
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
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Cross-sectional analysis
Small sample size
Healthy survivor cohort effect
Study Strength
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Comprehensive physical assessment
inclusive of an echocardiogram on 100
people living to advanced age
Conclusions (1)
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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)
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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
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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