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