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. 2014 Oct;2(5):489-99.
doi: 10.1016/j.jchf.2014.03.014. Epub 2014 Sep 3.

Impact of general and central adiposity on ventricular-arterial aging in women and men

Peter Wohlfahrt  1 , Margaret M Redfield  2 , Francisco Lopez-Jimenez  2 , Vojtech Melenovsky  3 , Garvan C Kane  2 , Richard J Rodeheffer  2 , Barry A Borlaug  4
Affiliations

Impact of general and central adiposity on ventricular-arterial aging in women and men

Peter Wohlfahrt et al. JACC Heart Fail. 2014 Oct.

Abstract

Objectives: The aim of this study was to assess the effects of central and general obesity measures on long-term longitudinal changes in ventricular-arterial mechanics.

Background: Obesity, female sex, and ventricular-arterial stiffening are associated with the development of heart failure with preserved ejection fraction. Fat distribution and chronic changes in body composition may affect longitudinal changes in LV properties, independent of arterial load.

Methods: In 1,402 subjects from a randomly selected, community-based population, comprehensive echo-Doppler echocardiography was performed at two examinations separated by 4 years. From this population, 788 subjects had paired data adequate for determining left ventricular end-systolic elastance (Ees), end-diastolic elastance (Eed), and effective arterial elastance (Ea).

Results: Over 4 years, Ea was decreased by 3% in tandem with improved blood pressure control, whereas Ees and Eed were increased by 14% and 8% (all, p < 0.001). Greater weight loss over 4 years was associated with progressively greater decreases in Ea in men and women. After adjustment for Ea change, weight gain was correlated with increases in Eed in both women and men. Central obesity was associated with greater age-related increases in Ees in women but not in men, independent of arterial load, but central obesity did not predict changes in Eed or Ea.

Conclusions: In these subjects, weight gain was associated with increases in LV diastolic stiffness, even after adjustment for changes in arterial afterload, whereas weight loss was associated with reductions in arterial stiffness. Age-related LV systolic stiffening was increased in women, but not in men, with central obesity. Strategies for promoting weight loss and reducing central adiposity may be effective in preventing heart failure with preserved ejection fraction, particularly in women.

Keywords: aging; heart failure; obesity; vascular stiffness; ventricular stiffness.

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Conflict of interest statement

Disclosures: We have no conflicts of interest to report.

Figures

Figure 1
Figure 1. Arterial elastance (la), end-diastolic stiffness (1b), end-systolic stiffness (1c) and ventricular-arterial coupling ratio (Id) change over time by sex
Data are expressed as estimated marginal mean and SEM. The influence of sex, time and their interaction was assessed. Ea – arterial elastance; Eed – end-diastolic stiffness; Ees – end-systolic stiffness; Ea/Ees – ventricular-arterial coupling ratio
Figure 2
Figure 2. Arterial elastance at Exam 1 and Exam 2 (Panel A) and arterial elastance change between exams (Panel B) by weight change quartiles in women and men
Data are adjusted for age and sex. *p<0.05 for the difference from Exam 1. Ea – arterial elastance; ΔEa – arterial elastance change between exams
Figure 3
Figure 3. End-diastolic stiffness at Exam 1 and Exam 2 (Panel A) and end-diastolic stiffness change between exams (Panel B) by weight change quartiles in women and men
Data are adjusted for age, sex and arterial elastance change between exams. *p<0.05 for the difference from Exam 1. Eed – end-diastolic stiffness; ΔEa – end-diastolic stiffness change between exams
Figure 4
Figure 4. A&B: End-systolic stiffness at Exam 1 and Exam 2 (Panel A) and end-systolic stiffness change between exams (Panel B) by neck-to-height quartiles at Exam 1 in women; C&D: End-systolic stiffness at Exam 1 and Exam 2 (Panel C) and end-systolic stiffness change between exams (Panel D) by insulin level quartiles at Exam 1 in women
Data are adjusted for age and arterial elastance change between exams. *p<0.05 for the difference from Exam 1 Ees – end-systolic stiffness; ΔEa end-systolic stiffness change between exams
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Comment in

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