Left ventricular growth response to exercise and cigarette smoking: data from LARGE Heart

J R Payne¹, K I Eleftheriou¹, L E James¹, E Hawe¹, J Mann¹, A Stronge², P Kotwinski¹, M World³, S E Humphries¹, D J Pennell⁴, H E Montgomery⁵

¹ Centre for Cardiovascular Genetics, BHF Laboratories, Royal Free & University College Medical School, London, UK
² Army Training Regiment Lichfield, Staffordshire, UK
³ Royal Centre for Defence Medicine, Selly Oak Hospital, Birmingham, UK
⁴ Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
⁵ Institute for Human Health and Performance, UCL Archway Campus, Archway, London, UK

Correspondence to:
H Montgomery
Institute for Human Health and Performance, University College London, Ground Floor, Charterhouse Building, Archway Campus, Highgate Hill, London N19 5LW, UK;h.montgomery{at}ucl.ac.uk

Background: Increasing left ventricular mass is a risk factor for cardiovascular morbidity and mortality.

Objective: To examine the possible association of smoking with the left ventricular growth response in men.

Methods: Left ventricular mass was measured in 309 army recruits before and after an identical 12-week physical training programme. Left ventricular mass was determined using cardiovascular magnetic resonance.

Results: Left ventricular mass increased with training (mean (standard deviation (SD)) 3.83 (10.81) g, p<0.001). By univariate analysis, exercise-induced change in left ventricular mass was positively associated with cigarette smoking (mean (SD) 1.69 (11.10) g v 4.76 (10.23) g for non-smokers v ex- and current smokers, respectively; p = 0.026), whereas age, height, diastolic and systolic blood pressure (SBP), alcohol consumption or indices of physical activity were not significantly associated with change in left ventricular mass. Multivariate analysis showed body weight, smoking status and SBP to be independent predictors of left ventricular mass (incremental R² = 3.4%, p = 0.004; R² = 4.9%, p = 0.024; and R² = 1.7%, p = 0.041, respectively).

Conclusions: Cigarette smoking and SBP are associated with exercise-induced left ventricular growth in young men. The positive association of smoking with changes in left ventricular mass is surprising, given the limited exposure of these subjects to smoking, and although these data do not prove causation, they are of great interest to those trying to uncover the drivers of left ventricular hypertrophy, as well as to those examining the possible ill-effects of smoking in the young.

Abbreviations: CMR, cardiovascular magnetic resonance; CPD, cigarettes smoked per day; DBP, diastolic blood pressure; LARGE Heart Study, Lichfield Army Recruit Growth in Exercise Heart Study; SBP, systolic blood pressure

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