Impact of Long-Term Burden of Excessive Adiposity and Elevated Blood Pressure From Childhood on Adulthood Left Ventricular Remodeling Patterns

Abstract

BACKGROUND Cardiovascular risk factors are associated with left ventricular hypertrophy (LVH), but little is known regarding related impact of longitudinal measures of childhood adiposity and left ventricular (LV) hemodynamics. OBJECTIVES The aim of this study is to examine the cumulative long-term burden and trends of excessive adiposity and elevated blood pressure (BP) during childhood on adult LVH and LV geometric remodeling patterns. Methods This longitudinal study consisted of 1,061 adults, aged 24 to 46 years, who had been examined 4 or more times for body mass index (BMI) and BP starting in childhood with an average follow-up of 28.0 years. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI and BP from childhood to adulthood. Four LV geometric types were defined as normal, concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH), all based on LV mass indexed for body height (m2.7) and relative wall thickness. Results Higher values of BMI and systolic and diastolic BP of childhood and adulthood, as well as total AUC and incremental AUC were all significantly associated with higher LV mass index and LVH, adjusted for race, sex, and age. In addition, higher values of BMI and BP of childhood and adulthood, total AUC, and incremental AUC were significantly associated with EH and CH but not CR. Importantly, all these measures of BMI had a consistently and significantly greater influence on EH than measures of BP. Conclusions These findings indicate that the adverse influence of excessive adiposity and elevated BP levels on LVH begins in childhood.