Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort

Objectives: The purpose of this study was to assess the independent effect of increased body size on left ventricular (LV) diastolic function.

Background: Obese and overweight persons are at increased risk of heart failure. Left ventricular diastolic dysfunction is an asymptomatic condition associated with future heart failure. It is unclear whether obesity and overweight are independently associated with LV diastolic dysfunction.

Methods: The LV diastolic function was evaluated in 950 participants from the CABL (Cardiovascular Abnormalities and Brain Lesions) study by traditional and tissue Doppler imaging. Peak early transmitral diastolic flow velocity (E), late transmitral diastolic flow velocity (A), and early diastolic mitral annulus velocity (E') were measured, and E/A and E/E' were calculated. The study sample was divided into 3 groups: normal weight (body mass index [BMI] <25.0 kg/m(2)), overweight (BMI 25.0 to 29.9 kg/m(2)), and obese (BMI ≥30 kg/m(2)).

Results: In multivariate analyses, BMI was independently associated with higher E, A, and E/E', an indicator of LV filling pressure (all p ≤ 0.01). Overweight and obese had lower E' (both p < 0.01) and higher E/E' (both p < 0.01) than normal weight participants. The E/A was lower in obese subjects than in normal weight subjects (p < 0.01). The risk of diastolic dysfunction was significantly higher in overweight subjects (adjusted odds ratio: 1.52, 95% confidence interval: 1.04 to 2.22) and obese subjects (adjusted odds ratio: 1.60, 95% confidence interval: 1.06 to 2.41) compared to normal weight subjects.

Conclusions: Increased BMI was associated with worse LV diastolic function independent of LV mass and associated risk factors. The increased risk of LV diastolic dysfunction in both overweight and obese persons may partially account for the increased risk of heart failure associated with both conditions.