Abstract
Background
Global longitudinal strain (GLS) of the left ventricle (LV) has proved to be a strong predictor of cardiovascular morbidity and mortality. GLS declines throughout adult-life as the LV remodels and adapts. Information on the impact of cardiac risk factors such as male sex, obesity, smoking status, hypertension, hypercholesterolemia, and diabetes on GLS through time has not yet been investigated.
Purpose
The aim of the present study was to investigate the impact of age, sex, body mass index (BMI), smoking status (current and previous vs never), mean arterial blood pressure (MAP), total plasma cholesterol (TPC), and HbA1c on GLS in the general population over a 10-year period.
Method
A total of 689 citizens recruited from the general population participated in the 4th and 5th Copenhagen City Heart Study (CCHS4 and CCHS5) a prospective longitudinal study. At CCHS4 the mean age was 51 years and 45% were male. The average decline in GLS during the follow-up period was −0.65%. All participants underwent two echocardiographic examinations median 10.4 [IQR: 10.2, 10.9] years apart along with thorough health examinations. All analyses were adjusted for baseline GLS value (CCHS4 value).
Results
In regression models, increasing age, male sex, increasing BMI, MAP, hypertension, increasing HbA1c, and diabetes proved to be significantly associated with increased decline in GLS. Relationship between significant continuous cardiovascular risk factors and ΔGLS are displayed in restricted spline curves (Figure 1). In a multivariable regression model including all the investigated cardiovascular risk factors, estimated glomerular filtration rate, plasma pro B-type natriuretic peptide, heart rate, and previous ischemic heart disease, age (standardized β-coef. = −0.10, P=0.005), male sex (standardized β-coef. = −0.16, P<0.001), and MAP (standardized β-coef. = −0.07, P=0.009) remained independent predictors of an accelerated decline in GLS during a 10-year period.
Restricted cubic spline curves
Conclusion
In the general population increasing age, male sex, and increasing MAP are all independently associated with an accelerated decline in GLS over a 10-year period.
Impact of smoking status on weight loss and cardiovascular risk factors