Impact of Long-term Burden of Excessive Adiposity and Elevated Blood Pressure from Childhood on Adult Left Ventricular Remodeling Patterns: The Bogalusa Heart Study

Left ventricular hypertrophy (LVH) independently predicts increased cardiovascular (CV) morbidity and mortality (1,2). It has been well documented that CV risk factors are strongly associated with the development of LVH. Among traditional CV risk factors, obesity and hypertension are recognized as the most important determinants of LVH in the general population (3–6). During the last few decades, evidence from epidemiologic and clinical studies indicates that measures of obesity are strong predictors of LVH, especially eccentric LVH (3). Also, elevated blood pressure (BP) plays a driving role in activating LV myocardial growth through chronic hemodynamic overload and increased central pressure (4). On the other hand, the importance of longitudinal changes of adiposity measures and BP relative to the development of LVH is not fully understood, particularly the impact on LV geometry. We now well recognize that cardiovascular disease (CVD) begins early in life (7,8). This concept of “childhood origins” of CVD is supported by numerous publications from 4 large-scale, population-based childhood cohorts followed into adulthood (Bogalusa [Louisiana], Muscatine [Iowa], Finland, and Australia) that are now collaborating as the i3C (International Childhood Cardiovascular Cohort) Consortium (8). Previous studies, including ours, have shown that the association between CV risk factors and excessive cardiac growth occurs in children and adolescents (9–12), and early life risk factors significantly predict adult LVH and LV geometric patterns (13,14). However, information is lacking regarding the relationship between life-course burden of CV risk factors starting in childhood and adult LVH and LV geometric remodeling patterns. This study aims to examine the impact of cumulative long-term burden and trends of excessive adiposity and elevated BP measured from childhood to adulthood on the development of LVH and LV geometric patterns in a biracial cohort enrolled in the Bogalusa Heart Study.