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Direct, inflammation-mediated and blood-pressure-mediated effects of total and abdominal adiposity on diastolic function: EPIPorto study

2015; Elsevier BV; Volume: 191; Linguagem: Inglês

10.1016/j.ijcard.2015.04.250

1874-1754

Ricardo Fontes‐Carvalho, Alexandra Gonçalves, Mílton Severo, Patrícia Lourenço, Francisco Rocha Gonçalves, Paulo Bettencourt, Adelino Leite‐Moreira, Ana Azevedo,

Body Composition Measurement Techniques

Obesity has been associated with subclinical diastolic dysfunction and increased risk of heart failure. Our aims were to evaluate the age- and sex-specific role of total and abdominal adiposity on diastolic function and to assess the direct and indirect pathophysiological mechanisms involved in this association.Within a population-based study (EPIPorto), a total of 1063 individuals aged ≥ 45 years (62% female; 62.4 ± 10.6 years) were evaluated using echocardiography, anthropometrics, electrical bioimpedance and blood tests. Diastolic function was assessed with using EAE/ASE consensus criteria. Worse diastolic function grades were associated with increased BMI, fat mass % and waist-to-height ratio (p for trend<0.001). The inverse association between adiposity and diastolic function was stronger in men and in the younger population. In multivariate analysis, waist-to-height ratio (per cm/cm) was associated with reduced E' velocity (adjusted β: -14.4; 95% CI: -21.1 to -7.6; p<0.001) and increased E/E' ratio (adjusted β: 9.7, 95% CI: 5.4-10.0; p<0.001), among men<65 years. Both direct and indirect mechanisms were involved in the E' velocity decrease by waist-to-height ratio in participants<65 years. The effect was mainly direct in men (81.3%), while it was mostly indirect in women, through systolic blood pressure (50.8%) and inflammation (15.1%).Adiposity, especially abdominal, was associated with worse diastolic function. This association was more important in men and in the younger population. The causal mechanisms involved were sex-specific, with mostly direct effects among men and blood-pressure-mediated among women.