Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland; Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Atherosclerosis. 2023 Sep;380:117197. doi: 10.1016/j.atherosclerosis.2023.117197. Epub 2023 Aug 4.
The longitudinal relations of cardiac indices with the aorta and carotid vessel and the time sequence for early cardiac disease development are uncharacterized in youth. We examined the temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) with left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD).
From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 adolescents (1011 females) at a mean (SD) age 17.7 (0.3) years were followed up for 7 years. Vicorder-measured cfPWV and ultrasound-measured cIMT were grouped in tertiles as low (reference), moderate, and high. Echocardiography measured cardiac abnormalities are left ventricular mass indexed for height (LVMI) ≥51 g/m as LVH; relative wall thickness ≥44 as hiRWT; LVD function E/A <1.5 as LVD dysfunction (LVDD); and LV filling pressure E/e' ≥8 as hiLVFP. Data were analysed with generalized logit mixed-effect models, cross-lagged path, and mediation structural equation models adjusting for cardiometabolic and lifestyle factors.
Over follow-up, LVH prevalence increased from 3.6% to 7.2% and LVDD from 11.1 to 16.3%. High cfPWV progression was associated with worsening LVH [Odds ratio 1.23 (1.13-1.35); p < 0.001] in the total cohort, males, overweight/obese, and normotensive. High cfPWV progression was associated with worsening hiLVFP in the total cohort, females, and normal weight. Likewise, high cIMT progression was associated with worsening LVH [1.27 (1.26-1.27); p < 0.0001] in the total cohort, overweight/obese and elevated BP/hypertensive. Neither cfPWV nor cIMT progression was associated with worsening hiRWT in the total cohort. In cross-lagged models, higher baseline cfPWV was associated with future LVMI (β = 0.06, SE, 5.14, p = 0.035), RWT, LVDF, and LVFP. However, baseline LVMI, RWT, LVDF, and LVFP were not associated with follow-up cfPWV. Baseline cIMT was not associated with follow-up cardiac indices and vice versa. Cumulative increased systolic blood pressure (34.3% mediation) and insulin resistance (15.1% mediation) mediated the direct associations of cumulative cfPWV with cumulative LVMI.
Arterial stiffness progression temporally preceded worsening structural and functional cardiac damage in youth with increased systolic blood pressure and insulin resistance partly mediating the relationships. Future interventions aimed at attenuating premature cardiac damage in adolescents and young adults may consider a simultaneous treatment of both arterial stiffness, elevated blood pressure and insulin resistance.
在年轻人中，心脏指数与主动脉和颈动脉血管的纵向关系以及早期心脏病发展的时间顺序尚不清楚。我们研究了颈动脉-股动脉脉搏波速度（cfPWV）和颈动脉内中膜厚度（cIMT）与左心室肥厚（LVH）和舒张功能障碍（LVDD）的时间纵向关联。
来自英国阿冯纵向研究的父母和孩子出生队列，1856 名青少年（1011 名女性）平均（SD）年龄为 17.7（0.3）岁，随访 7 年。使用 Vicorder 测量 cfPWV 和超声测量 cIMT，将其分为低（参考）、中、高三组。超声心动图测量的心脏异常为左心室质量指数（LVMI）≥51 g/m 为 LVH；相对壁厚度≥44 为 hiRWT；LVD 功能 E/A <1.5 为 LVD 功能障碍（LVDD）；LV 充盈压 E/e'≥8 为 hiLVFP。使用广义对数混合效应模型、交叉滞后路径和中介结构方程模型分析数据，调整了心血管代谢和生活方式因素。
随访期间，LVH 的患病率从 3.6%增加到 7.2%，LVDD 从 11.1%增加到 16.3%。在总队列、男性、超重/肥胖和血压正常的人群中，cfPWV 进展与 LVH 恶化相关[比值比 1.23（1.13-1.35）；p<0.001]。在总队列、女性和正常体重人群中，cfPWV 进展与 hiLVFP 恶化相关。同样，cIMT 进展与 LVH 恶化相关[1.27（1.26-1.27）；p<0.0001]，在总队列、超重/肥胖和血压升高/高血压人群中。在总队列中，cfPWV 或 cIMT 的进展均与 hiRWT 的恶化无关。在交叉滞后模型中，较高的基线 cfPWV 与未来的 LVMI（β=0.06，SE，5.14，p=0.035）、RWT、LVDF 和 LVFP 相关。然而，基线 LVMI、RWT、LVDF 和 LVFP 与随访后的 cfPWV 无关。基线 cIMT 与随访后的心脏指数无关，反之亦然。累积收缩压（34.3%的中介作用）和胰岛素抵抗（15.1%的中介作用）部分介导了累积 cfPWV 与累积 LVMI 的直接关联。
动脉僵硬度的进展先于年轻人结构性和功能性心脏损伤的恶化，其中包括收缩压升高和胰岛素抵抗，这部分解释了这种关联。未来旨在减轻青少年和年轻成年人早期心脏损伤的干预措施可能需要同时治疗动脉僵硬度、血压升高和胰岛素抵抗。
