Wilson Cañon-Montañez1, Angela B S Santos2, Lisandra A Nunes3, Julio C G Pires4, Claudia M V Freire5, Antonio L P Ribeiro5, José G Mill6, Marina Bessel7, Bruce B Duncan7, Maria Inês Schmidt7, Murilo Foppa8. 1. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Facultad de Ciencias de la Salud, Universidad de Santander, Bucaramanga, Colombia. 2. Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 3. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 4. Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 5. Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 6. Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, Brazil. 7. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 8. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: mufoppa@hcpa.edu.br.
Abstract
INTRODUCTION AND OBJECTIVES: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association. METHODS: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease. RESULTS: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52±9 years), 444 (42%) had MS. Those with MS had worse GLS (-18.0%±2.5%) than those without (-19.0%±2.4%; P<.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference=0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS -16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS -14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS -13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values. CONCLUSIONS: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.
INTRODUCTION AND OBJECTIVES: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association. METHODS: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease. RESULTS: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52±9 years), 444 (42%) had MS. Those with MS had worse GLS (-18.0%±2.5%) than those without (-19.0%±2.4%; P<.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference=0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS -16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS -14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS -13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values. CONCLUSIONS:Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.