Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: A population-based cohort study.
General obesity, measured by body mass index (BMI), and abdominal adiposity, measured as waist circumference (WC) and waist-to-hip ratio (WHR), are associated with heart failure and cardiovascular events. However, the relationship of general and abdominal obesity with subclinical left ventricular (LV) dysfunction is unknown. We assessed the association of general and abdominal obesity with subclinical LV systolic dysfunction in a population-based elderly cohort.



Participants from the Cardiovascular Abnormalities and Brain Lesions study underwent measurement of BMI, WC, and WHR. Left ventricular systolic function was assessed by two-dimensional echocardiographic LV ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS). The study population included 729 participants (mean age 71 ± 9 years, 60% women). In multivariate analysis, higher BMI (but not WC and WHR) was associated with higher LVEF (β = 0.11, P = 0.003). Higher WC (β = 0.08, P = 0.038) and higher WHR (β = 0.15, P < 0.001) were associated with lower GLS, whereas BMI was not (P = 0.720). Compared with normal WHR, high WHR was associated with lower GLS in all BMI categories (normal, overweight, and obese), and was associated with subclinical LV dysfunction by GLS both in participants without [adjusted odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.6, P = 0.020] and with general obesity (adjusted OR 5.4, 95% CI 1.1-25.9, P = 0.034). WHR was incremental to BMI and risk factors in predicting LV dysfunction.



Abdominal adiposity was independently associated with subclinical LV systolic dysfunction by GLS in all BMI categories. BMI was not associated with LV dysfunction. Increased abdominal adiposity may be a risk factor for LV dysfunction regardless of the presence of general obesity.
Department of Medicine, Columbia University, New York, NY, USA.
Cesare
C
Russo
Department of Medicine, Columbia University, New York, NY, USA.
Fusako
F
Sera
Department of Biostatistics, Columbia University, New York, NY, USA.
Zhezhen
Z
Jin
Cardiology Unit, Department of Heart and Vessels, S.G. Moscati National Hospital, Avellino, Italy.
Vittorio
V
Palmieri
Department of Medicine, Columbia University, New York, NY, USA.
Shunichi
S
Homma
Department of Neurology, Department of Public Health Sciences, University of Miami, Miami, FL, USA.
Tatjana
T
Rundek
Departments of Neurology and Epidemiology, Columbia University, New York, NY, USA.
Mitchell S V
MS
Elkind
Department of Neurology, Department of Public Health Sciences, University of Miami, Miami, FL, USA.|Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA.
Ralph L
RL
Sacco
Department of Medicine, Columbia University, New York, NY, USA.
Marco R
MR
Di Tullio
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000453:epidemiology*; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055105:Waist Circumference; D049629:Waist-Hip Ratio
Abdominal adiposity; Echocardiography; Global longitudinal strain; Obesity; Systolic dysfunction