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Original research article
Risk factors for longitudinal changes in left ventricular diastolic function among women and men
  1. Oscar L Rueda-Ochoa1,2,
  2. Marco A Smiderle-Gelain3,
  3. Dimitris Rizopoulos4,
  4. Klodian Dhana1,
  5. Jan-Kees van den Berge1,
  6. Luis E Echeverria5,
  7. M Arfan Ikram1,
  8. Jaap W Deckers6,
  9. Oscar H Franco1,
  10. Maryam Kavousi1
  1. 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
  2. 2 Department of Basic Sciences, Universidad Industrial de Santander, Bucaramanga, Colombia
  3. 3 Department of Cardiology, Federal University of Health Sciences UFCSPA, Porto Alegre, Porto Alegre, Brazil
  4. 4 Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
  5. 5 Heart Failure and Heart Transplant Clinic, Fundacion Cardiovascular de Colombia, Floridablanca, Colombia
  6. 6 Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Maryam Kavousi, Department of Epidemiology, Erasmus MC, Rotterdam 3000 CA, The Netherlands; m.kavousi{at}


Objective To evaluate changes in left ventricular diastolic function (LVDF) parameters and their associated risk factors over a period of 11 years among community-dwelling women and men.

Methods Echocardiography was performed three times among 870 women and 630 men (age 67±3 years) from the prospective population-based Rotterdam Study during a period of 11-year follow-up. Changes in six continuous LVDF parameters were correlated with cardiovascular risk factors using a linear-mixed effect model (LMM).

Results In women, smoking was associated with deleterious longitudinal changes in deceleration time (DT) (Beta (β): 7.73; 95% CI 2.56 to 12.9) and high-density lipoprotein cholesterol was associated with improvement of septal e’ (β: 0.37; 95% CI 0.13 to 0.62) and E/e’ ratio (β: −0.46; 95% CI −0.84 to –0.08) trajectories. Among men, diabetes was associated with deleterious longitudinal changes in A wave (β: 3.83; 95% CI 0.06 to 7.60), septal e’ (β: −0.40; 95% CI −0.70 to –0.09) and E/e’ ratio (β: 0.60; 95% CI 0.14 to 1.06) and body mass index was associated with deleterious longitudinal changes in A wave (β: 1.25; 95% CI 0.84 to 1.66), E/A ratio (β: −0.007; 95% CI −0.01 to –0.003), DT (β: 0.86; 95% CI 0.017 to 1.71) and E/e’ ratio (β: 0.12; 95% CI 0.06 to 0.19).

Conclusions Smoking among women and metabolic factors (diabetes mellitus and body mass index) among men showed larger deleterious associations with longitudinal changes in LVDF parameters. The favourable association of HDL was mainly observed among women. This study, for the first time, evaluates risk factors associated with changes over time in continuous LVDF parameters among women and men and generates new hypothesis for further medical research.

  • echocardiography, doppler
  • left ventricular diastolic function
  • cohort study
  • sex difference
  • risk factors

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  • OLR-O and MAS-G contributed equally.

  • Contributors Planning: OLR-O, MAS-G, MK, OHF, KD, JD. Conduct: OLR-O, MAS-G, MK, DR. Reporting: OLR-O, MAS-G, MK, DR, OHF, KD, JD, J-KvdB, AI, LEE.

  • Funding The Rotterdam Study is funded by Erasmus MC and Erasmus University, Rotterdam, the Netherlands; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. Oscar L. Rueda-Ochoa received scholarship from COLCIENCIAS-Colombia; Marco Antônio Smiderle Gelain from CnPQ, Brazil; Maryam Kavousi is supported by the VENI grant (91616079) from The Netherlands Organization for Health Research and Development (ZonMw).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.