Longitudinal tracking of left ventricular mass over the adult life course: clinical correlates of short- and long-term change in the framingham offspring study.
Longitudinal tracking of left ventricular mass over the adult life course: clinical correlates of short- and long-term change in the framingham offspring study.
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DOI：
10.1161/circulationaha.108.824243
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发表时间：
2009-06-23
期刊：
影响因子：
37.8
通讯作者：
Vasan RS
中科院分区：
文献类型：
--
作者：
Lieb W;Xanthakis V;Sullivan LM;Aragam J;Pencina MJ;Larson MG;Benjamin EJ;Vasan RS
关于成人一生中左心室（LV）质量的纵向追踪和这种变化的决定因素的信息有限。我们使用多层次模型对4217名Framingham研究参与者（平均年龄45岁，53%为女性）在16年期间的左室质量相关性进行前瞻性评估，对每个个体（11,762例观察）进行多达4次连续常规超声心动图观察。年龄、性别、体重指数（BMI）、收缩压（BP）、抗高血压治疗、吸烟和糖尿病与左室质量的纵向测量有关。女性和糖尿病患者的左室质量随着年龄的增长而急剧增加（与男性和非糖尿病患者相比；相互作用p分别<0.0001和0.0003）。女性的左室质量也随着BMI的增加而增加（与男性相比，p=0.04）。随着时间的推移，这些风险因素达到最佳值的参与者左室质量的增加较小。评估短期（4年）左室质量变化的分析（2605个独特个体提供4494个观察结果）确定了影响其长期轨迹的相同关键决定因素，即BMI、性别、收缩压、抗高血压治疗和吸烟。我们在一个大型社区样本中进行的纵向观察发现，高血压、过度肥胖、吸烟和糖尿病是成年过程中左室质量跟踪的基本决定因素。这些观察结果与在中年维持这些风险因素的最佳水平将减轻老年左室肥厚和可能的心力衰竭的负担的观点是一致的。
Information is limited regarding the longitudinal tracking of left ventricular (LV) mass over the adult life-course and the determinants of such change. We used multi-level modeling to evaluate the correlates of LV mass prospectively over a 16-year period in 4217 Framingham study participants (mean age 45 years, 53% women) using up to 4 serial routine echocardiographic observations on each individual (11,762 observations). Age, sex, body mass index (BMI), systolic blood pressure (BP), antihypertensive treatment, smoking, and diabetes were related to longitudinal measures of LV mass. Women and participants with diabetes experienced a steeper increase in LV mass with advancing age (compared to men, and those without diabetes; p for interactions <0.0001and 0.0003, respectively). Women also displayed greater increments in LV mass with increasing BMI (compared to men, p=0.04 for interaction). Participants with optimal values of these risk factors experienced lesser increases in LV mass over time. Analyses evaluating short-term (4-year) changes in LV mass (2605 unique individuals providing 4494 observations) identified the same key determinants that influenced its long-term trajectory, i.e., BMI, sex, systolic BP, antihypertensive treatment, and smoking. Our longitudinal observations on a large community-based sample identified higher blood pressure, excess adiposity, smoking and diabetes as fundamental determinants of LV mass tracking over the adult life course. These observations are consistent with the notion that maintenance of optimal levels of these risk factors in midlife will reduce the burden of LV hypertrophy, and possibly heart failure, in older age.