Association of Patterns of Change in Adiposity With Diastolic Function and Systolic Myocardial Mechanics From Early Adulthood to Middle Age: The Coronary Artery Risk Development in Young Adults Study

Background The aim of this study was to determine whether long-term patterns of change in adiposity throughout young adulthood are associated with systolic and diastolic function in midlife. Methods Participants in the Coronary Artery Risk Development in Young Adults study, a multicenter, population-based cohort, underwent repeated anthropometric assessment (body mass index [BMI], waist circumference, and waist-to-hip ratio) from examination years 0 to 25. At year 25, longitudinal, circumferential, and radial strain and tissue Doppler velocities were assessed by echocardiography. Group-based trajectory modeling was used to identify 25-year trajectories of change in anthropometric measures and to examine associations between trajectories of adiposity change and indices of cardiac mechanics. Results Among 3,310 participants, four distinct trajectories of BMI change were identified: stable BMI (36% of the cohort; mean ΔBMI, 1.6 kg/m 2 ), mild increase (40%; mean ΔBMI, 6.0 kg/m 2 ), moderate increase (18%; mean ΔBMI, 10.8 kg/m 2 ), and major increase (6%; mean ΔBMI, 15.5 kg/m 2 ). Trajectories of greater BMI increase were associated with lower adjusted e′ velocity and higher E/e′ ratio compared with the stable BMI group, independent of year 0 or year 25 BMI. Participants in increasing BMI trajectory groups compared with the stable BMI group had lower absolute longitudinal strain and greater odds of diastolic dysfunction, independent of year 0 BMI but not year 25 BMI. Similar patterns were observed for change in waist circumference and waist-to-hip ratio trajectory groups. Conclusions Steeper trajectories of BMI increase from young adulthood to middle age, a vulnerable period for weight gain, are independently associated with lower e′ velocity and higher E/e′ ratio, but not systolic dysfunction, in midlife.