Abstract P367: Association of Risk Factor Exposure Patterns Through Young Adulthood With Left Ventricular Structure/Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Donald M Lloyd-Jones ◽  
Laura Colangelo ◽  
Beth Lewis ◽  
Pamela Schreiner ◽  
Stephen Sidney ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
Young Adulthood ◽  
Latent Class ◽  
Middle Age ◽  
Cumulative Risk ◽  
Left Ventricular ◽  
Cumulative Exposure ◽  
Primordial Prevention ◽  
Exposure Patterns

Background: Data are sparse regarding associations of risk factors (RF) across young adulthood with development of adverse left ventricular (LV) structure and function by middle age, and it is unclear whether baseline, cumulative, or longitudinal RF exposure patterns best represent that risk. Methods: We included up to 2335 CARDIA participants (ppts) who had echocardiographic data from exam year (Y)5, Y25, and Y30, and RF data from at least 3 exams including Y0 and Y25. Echo outcomes included Y30 indexed LV end-systolic (ESD/ht) and -diastolic (EDD/ht) dimensions, and LV mass (M/ht 2.7 ), septal and posterior wall thickness, ejection fraction (EF), and incident adverse geometry (defined as LV concentric remodeling [CR], concentric hypertrophy [cLVH], or eccentric hypertrophy [eLVH]). We used multivariable linear, logistic or polytomous regression (as appropriate to endpoint) to examine associations of RF exposures measured as: 1) baseline (Y0); 2) change from Y0 to Y25; 3) cumulative exposure from Y0 to Y25 (e.g., pack-yrs, mmHg-yrs); or 4) latent class trajectories (using PROC TRAJ) from Y0 to Y25, with adjustment for demographics and relevant Y5 echo measures. Results: At Y30, ppts were 55±4 yrs, 56% women and 44% black; 12% smoked, mean BMI was 30.4±7, 37% had hypertension, and 17% diabetes; 20.5% had incident LVH; 4.5% EF<50%; and 37.2% adverse LV geometry. Models representing cumulative RF exposures tended to have the highest adjusted R 2 and lowest AIC for continuous and categorical Y30 LV outcomes. The table shows associations of cumulative RFs from Y0 to Y25 with incident LVH, EF<50%, and adverse LV geometry at Y30. Few RFs were consistently associated with Y25-Y30 change in echo measures, but they included education and SBP. Conclusions: Among initially healthy young adults, cumulative risk factor exposures (often within clinically normative ranges) over 25 years are significantly associated with continuous LV echo measures and adverse LV outcomes by middle age, suggesting the importance of primordial prevention.

Abstract 19900: Impact of Baseline Fitness in Young Adulthood and Age Related Fitness Changes on Cardiac Structure and Function in Middle Age: The CARDIA Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ambarish Pandey ◽  
Norrina Allen ◽  
Colby Ayers ◽  
Jared Reis ◽  
Henrique Moreira ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
Young Adulthood ◽  
Middle Age ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Structure And Function ◽  
Lv Function ◽  
Increased Risk ◽  
And Function

Introduction: Low cardiorespiratory fitness (CRF) in mid-life is a significant risk factor for heart failure (HF) at a later age. However, the contribution of CRF in early adulthood to HF risk is not well understood. Because of the established association of subclinical abnormalities in left ventricular (LV) structure and function with HF risk, we studied the association between early life CRF levels and measures of LV structure and function in middle-age. Methods: We included the Coronary Artery Risk Development in Young Adults (CARDIA) study participants who had a maximal exercise treadmill test (modified Balke protocol) at year 0 and an echocardiogram at year 25. Percent change in CRF [ΔCRF (%)] was calculated in the subgroup of participants who had a repeat CRF test at year 20. Associations of baseline CRF and ΔCRF (%) with measures of LV structure [end-diastolic volume (LVEDV), relative wall thickness (RWT)] and function [global longitudinal strain (GLS), Septal & Lateral E/e`] were assessed using multivariable linear regression. Results: We included 3,433 participants (baseline age: 25 years, 55% women) in the study. After adjustment for baseline characterstics, cumulative cardiovascular risk factor burden, and baseline and follow up body mass index (BMI), lower baseline CRF was associated with higher septal E/e`(β = -0.05, p = 0.01), higher lateral E/e` (β = -0.06, p = 0.008), and lower LVEDV (β = 0.07, p = 0.004). In contrast, CRF was not associated with GLS (p = 0.22) and RWT (p=0.27). Among participants with repeat CRF test (n =2,544), ΔCRF (%) was associated with LVEDV but not with measures of LV function. The association of baseline CRF with E/e` did not attenuate after additional adjustment for ΔCRF (%) (Table). Conclusions: Lower CRF in young adulthood is associated with subclinical abnormalities in diastolic function in middle age. These findings suggest that low CRF may identify young adults at increased risk of HF with preserved ejection fraction in later life.

Abstract 13246: The Impact of Body-Mass Index Trajectories During Early Adulthood on Cardiac Mechanics in Middle Age: The CARDIA Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sadiya S Khan ◽  
Sanjiv J Shah ◽  
Kiang J Liu ◽  
Cora E Lewis ◽  
Christina Shay ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Young Adulthood ◽  
Cardiac Dysfunction ◽  
Middle Age ◽  
Cardiac Mechanics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Impact ◽  
Baseline Bmi

Introduction: Obesity is a risk factor for left ventricular dysfunction and incident heart failure. We hypothesized that baseline body mass index (BMI) and trajectories in weight change through young adulthood are associated with abnormal cardiac mechanics in middle age. Methods: We examined 2,735 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMI was calculated at exam years 0, 2, 5, 7, 10, 15, 20, 25. 2D echo was performed with speckle-tracking analysis. Left ventricular ejection fraction (LVEF) and global longitudinal, circumferential, and radial strain (GLS, GCS, GRS, respectively) were measured at y25. Group-based modeling with latent class analysis (PROC TRAJ) was used to identify trajectories in relative changes in BMI (% change in BMI from baseline at each exam). Linear regression examined associations between baseline BMI and trajectory of BMI change and absolute GLS, GCS, and GRS at y25 adjusting for demographics, risk factors, and echo parameters. Results: Mean age at baseline was 25±4 years. Baseline BMI at y0 was significantly associated with mean GLS at y25 (p=0.01), but not GRS or GCS. We identified 4 distinct trajectories of relative BMI change: stable weight (36% of sample), mild increase (40%), moderate increase (18%), and major increase (6%) in weight (Figure). At y25, there was no difference in LVEF across the 4 BMI trajectory groups (P=NS). After adjustment for clinical variables and baseline BMI, absolute GLS was lower in groups with BMI increases (overall P<0.001). GRS and GCS were not significantly different between the groups. Conclusion: In conclusion, baseline BMI and increases in BMI during young adulthood are significantly associated with the presence of subclinical cardiac dysfunction in middle age despite normal EF. This novel characterization of BMI trajectories across young adulthood may assist in improving understanding of the impact of weight gain and obesity on cardiac dysfunction.

Abstract P181: Young Adult Risk Factor Burden and Sleep Hypertension in Middle-Age: the Coronary Artery Risk Development in Young Adults Study

Circulation ◽  
2019 ◽  
Vol 139 (Suppl_1) ◽  
Author(s):  
John N Booth ◽  
Joseph Schwartz ◽  
Norrina Allen ◽  
Bryron Jaeger ◽  
Cora Lewis ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
Coronary Artery ◽  
Young Adult ◽  
Middle Age ◽  
Risk Factor Burden

scholarly journals Fasting Glucose Variability in Young Adulthood and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Diabetes Care ◽  
2018 ◽  
Vol 41 (12) ◽  
pp. 2579-2585 ◽  
Author(s):  
Michael P. Bancks ◽  
Mercedes R. Carnethon ◽  
David R. Jacobs ◽  
Lenore J. Launer ◽  
Jared P. Reis ◽  
...  
Keyword(s):  
Young Adults ◽  
Coronary Artery ◽  
Cognitive Function ◽  
Young Adulthood ◽  
Middle Age ◽  
Fasting Glucose ◽  
Glucose Variability

scholarly journals Trajectories of Body Mass Index from Young Adulthood to Middle Age among Canadian Men and Women

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Meng Wang ◽  
Yanqing Yi ◽  
Barbara Roebothan ◽  
Jennifer Colbourne ◽  
Victor Maddalena ◽  
...  
Keyword(s):  
Young Adulthood ◽  
Low Income ◽  
Latent Class ◽  
Middle Age ◽  
Normal Weight ◽  
Physically Active ◽  
Aboriginal Women ◽  
Bmi Trajectories ◽  
Bmi Trajectory

Knowledge regarding the heterogeneity of BMI trajectories is limited for the Canadian population. Using latent class growth modelling, four distinct BMI trajectories of individuals from young adulthood to middle age were identified for both women and men from the longitudinal data of the National Population Health Survey. The associations between BMI trajectories and the individuals’ sociodemographic characteristics and behavioural factors were also examined. Aboriginal women were found more likely to be in the long-term overweight or obese groups. It reveals that increased years of smoking, drinking, and being physically active were associated with lowering the BMI trajectory in all groups for both women and men, with some exceptions in the long-term normal weight group for men. Increased years of rural living, being employed, and living with low income were associated with raising the BMI trajectory in all groups for women and in some groups for men. Food insecurity was associated with raising the BMI trajectory in each group for both women and men.

Abstract 038: Cumulative Exposure To Sleep Disordered Breathing From Childhood Through Young Adulthood Is Associated With Impaired Endothelial Function

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Zhaohui Gao ◽  
Myra Qureshi ◽  
Baadal A Vachhani ◽  
Jiangang Liao ◽  
...  
Keyword(s):  
Young Adults ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Young Adulthood ◽  
Sleep Disordered Breathing ◽  
Population Based ◽  
Cumulative Exposure ◽  
Time Points ◽  
The Mean ◽  
Disordered Breathing

Introduction: Clinical and population-based studies in adults have shown that sleep disordered breathing (SDB) is associated with impaired endothelial function. However, there is a lack of population-based studies demonstrating an association between SDB and endothelial dysfunction in young adults using a developmental approach. Hypothesis: Exposure to SDB since childhood is associated with long-term impaired flow-mediated dilation (FMD) in young adulthood. Methods: We tested this hypothesis in a subsample of the Penn State Child Cohort, a population-based study of 700 children (median age 9y), of whom 421 were followed-up 6-13 years later during adolescence (median age 16y), and 178 have been followed-up 11-19 years later during young adulthood (median age 24y). Subjects (54.5% female, 20.8% racial/ethnic minority) underwent in-lab polysomnography to ascertain the apnea/hypopnea index (AHI) at all three time points, and ultrasounds to assess FMD in young adulthood. Based on the AHI truncated at ≥5 events/hour of sleep to include subjects already on positive airway pressure therapy, we averaged the exposure to AHI over the three time points (cAHI). The study outcomes were FMD, as a continuous measure, and endothelial dysfunction, defined as FMD<10.3% based on the median of the sample. Linear and logistic regression models simultaneously adjusted for sex, age, race/ethnicity, overweight and length of follow-up. Results: The mean cAHI was 1.31 (1.35) ranging from 0 to 5 and the mean FMD was 0.11 (0.04) ranging from 0.03 to 0.25. Linear models showed that cAHI was associated with significantly lower FMD in young adulthood (β = -0.006; 95% CI = -0.011, -0.0013; p = 0.014). To test the robustness of the analysis, we applied the same model with the square root of FMD as the outcome and similar results were obtained (β = -0.009; 95% CI = -0.016, -0.0017; p = 0.015). Logistic models showed that each point increase in cAHI was associated with 51% higher odds of endothelial dysfunction in young adulthood (OR = 1.51; 95% CI = 1.14, 2.06; p = 0.006). Conclusions: The preliminary data of this ongoing longitudinal study indicates that exposure to SDB during early stages of life is associated with increased risk for cardiovascular disease in young adults from the general population.

Abstract 05: Longer Duration of Obesity Beginning in Young Adulthood is Associated with Greater Left Ventricular Mass and Worse Left Ventricular Function in Middle-Age: The CARDIA Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jared P Reis ◽  
Norrina B Allen ◽  
Bethany Barone-Gibbs ◽  
Joyce M Lee ◽  
Cora E Lewis ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Young Adulthood ◽  
Middle Age ◽  
Left Ventricular ◽  
Lv Function ◽  
Obesity Epidemic ◽  
Lv Mass ◽  
Table Model ◽  
And Function

Background: As a result of the obesity epidemic, individuals are becoming obese at a younger age than in previous generations. Yet, few studies have determined the consequences of a longer duration of obesity. The present study examined whether the duration of obesity beginning early in adulthood is associated with left ventricular (LV) structure and function in middle-age. Methods: We studied 2,545 white and black adults aged 18-30 years without obesity [body mass index (BMI) <30 kg/m 2 ] at baseline in 1985-86 or clinically apparent heart disease through year 25 (2010-11) in the multicenter, community-based CARDIA study. Duration of obesity (years with BMI ≥30.0 kg/m 2 ) was calculated using repeat measurements of BMI performed 2, 5, 7, 10, 15, 20, and 25 years after baseline. Outcomes included LV mass and ejection fraction from an echocardiogram performed during the 25-year follow-up examination. Results: During follow-up, 994 participants became obese (39.1%); mean duration of obesity was 14.1 years. After adjustment for demographic and behavioral covariates, including year 25 BMI, a longer duration of obesity was associated with a greater LV mass and a lower ejection fraction (Table, model 1). Further adjustment for intermediate clinical covariates, including antihypertensive medication use, systolic blood pressure, heart rate, and diabetes only modestly attenuated these associations (Table, model 2). These associations were similar across white and black men and women (p-interaction>0.10, for all). Conclusions: Longer duration of obesity from young adulthood to middle-age was associated with significantly greater LV mass and marginally lower LV function in midlife, independent of concurrent BMI.

Abstract P107: Serum Urate Trajectories in Young Adulthood and Incident Cardiovascular Disease Events By Middle Age; The Coronary Artery Risk Development in Young Adults (cardia) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nagisa Morikawa ◽  
Michael P. Bancks ◽  
Yuichiro Yano ◽  
Masanori Kuwabara ◽  
Angelo L. Gaffo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Young Adults ◽  
Young Adulthood ◽  
Clinical Characteristics ◽  
Middle Age ◽  
Serum Urate ◽  
Hazard Ratios ◽  
Study Participants ◽  
Incident Cardiovascular Disease

Introduction: Higher levels of serum urate (UA) obtained on a single occasion have been shown to be associated with a higher risk of cardiovascular disease (CVD) events among middle-aged or older adults. However, little is known regarding UA trajectory patterns during young adulthood and their associations with CVD outcomes by middle age. Hypothesis: We hypothesize that higher UA trajectory is associated with a higher risk for CVD events compared to lower UA trajectories. Methods: We included data from 4845 CARDIA Study participants (mean age at the Year 20 exam 44.8±3.7 (37-55) years; 50.8% African American; 55.6% female). Sex-specific UA trajectories were assessed using group-based trajectory modeling (PROC TRAJ in SAS version 9.4) based on UA levels obtained at baseline (Year 0) and 10, 15, 20 years later. Covariates included age, sex, race, and clinical characteristics at Year 20 (body mass index, diabetes and creatinine). We estimated hazard ratios (HR) for CVD events (coronary heart disease, heart failure, and stroke) from Year 20 (2005-06) through 2017. Results: We identified 3 UA trajectories in men and 3 similar but lower UA trajectories in women, characterized by low-increasing (men: 30%; n=652, mean UA 5.1; women 43%, n=1191, mean UA 3.9), moderate-increasing (men: 52%; n=1290, mean UA 6.4; women 45%, n=1284, mean UA 5.0), and high-increasing UA (men: 17%; n=377, mean UA 8.0; women 12%, n=305, mean UA 6.4) (Figure 1). Sex-specific trajectories were pooled. Over a median follow-up of 10.9 years, 203 incident CVD events occurred. The adjusted HRs for CVD events were 0.98 (95%CI, 0.66-1.45) for the pooled moderate-increasing group and 1.77 (95%CI, 1.10-2.84) for the pooled high-increasing group compared to the pooled low-increasing group. Conclusions: High-increasing UA trajectory during young adulthood was associated with an greater risk of CVD events by middle age. Modeling UA trajectories may help identify young adults at higher risk for CVD events.

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