Journal of the American College of Cardiology
Volume 54, Issue 21 , Pages 1982-1989, 17 November 2009

The Aging Process of the Heart: Obesity Is the Main Risk Factor for Left Atrial Enlargement During Aging:

The MONICA/KORA (Monitoring of Trends and Determinations in Cardiovascular Disease/Cooperative Research in the Region of Augsburg) Study

  • Jan Stritzke, MD

      Affiliations

    • Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
    • ,
  • Marcello Ricardo Paulista Markus, MD

      Affiliations

    • Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
    • Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
    • Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
    • ,
  • Stefanie Duderstadt, MD

      Affiliations

    • Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
    • ,
  • Wolfgang Lieb, MD

      Affiliations

    • Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
    • ,
  • Andreas Luchner, MD

      Affiliations

    • Department of Internal Medicine II, University of Regensburg, Regensburg, Germany
    • ,
  • Angela Döring, MD

      Affiliations

    • HelmholtzZentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
    • ,
  • Ulrich Keil, MD

      Affiliations

    • Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
    • ,
  • Hans-Werner Hense, MD

      Affiliations

    • Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
    • ,
  • Heribert Schunkert, MD

      Affiliations

    • Department of Internal Medicine II, University of Lübeck, Lübeck, Germany
    • Corresponding Author InformationReprint requests and correspondence: Prof. Dr. Heribert Schunkert, Universität zu Lübeck, Medizinische Klinik II, D-23538 Lübeck, Germany
    • ,
  • MONICA/KORA Investigators

Received 25 March 2009; accepted 12 July 2009.

Objectives

This prospective study evaluated the association of obesity and hypertension with left atrial (LA) volume over 10 years.

Background

Although left atrial enlargement (LAE) is an independent risk factor for atrial fibrillation, stroke, and death, little information is available about determinants of LA size in the general population.

Methods

Participants (1,212 men and women, age 25 to 74 years) originated from a sex- and age-stratified random sample of German residents of the Augsburg area (MONICA S3). Left atrial volume was determined by standardized echocardiography at baseline and again after 10 years. Left atrial volume was indexed to body height (iLA). Left atrial enlargement was defined as iLA ≥35.7 and ≥33.7 ml/m in men and women, respectively.

Results

At baseline, the prevalence of LAE was 9.8%. Both obesity and hypertension were independent predictors of LAE, obesity (odds ratio [OR]: 2.4; p < 0.001) being numerically stronger than hypertension (OR: 2.2; p < 0.001). Adjusted mean values for iLA were significantly lower in normal-weight hypertensive patients (25.4 ml/m) than in obese normotensive individuals (27.3 ml/m; p = 0.016). The highest iLA was found in the obese hypertensive subgroup (30.0 ml/m; p < 0.001 vs. all other groups). This group also presented with the highest increase in iLA (+6.0 ml/m) and the highest incidence (31.6%) of LAE upon follow-up.

Conclusions

In the general population, obesity appears to be the most important risk factor for LAE. Given the increasing prevalence of obesity, early interventions, especially in young obese individuals, are essential to prevent premature onset of cardiac remodeling at the atrial level.

Key Words: left atrial enlargement, obesity, hypertension, population

Abbreviations and Acronyms: BMI, body mass index, BSA, body surface area, iLA, indexed left atrial volume, LA, left atrial, LAE, left atrial enlargement, LV, left ventricular, SV, stroke volume

 

 The MONICA Augsburg study was initiated by Dr. Keil and colleagues. The KORA Group consists of H. E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John, and their coworkers who are responsible for the design and conduct of the KORA studies. This work was supported by the Kompetenznetz Herzinsuffizienz (German Heart Failure Network) funded by the Federal Ministry of Education and Research, FKZ 01GI0205; the Deutsche Forschungsgemeinschaft (Schu 672/9-1, Schu 672/10-1, and Schu 672/12-1); the Bundesministerium für Forschung und Technologie (to Drs. Döring, Hense, and Schunkert); the Medical Faculty, University of Lübeck (to Dr. Stritzke; A39-2005); and the European-Union–sponsored project Cardiogenics (LSH-2005-037593). The KORA (Cooperative Research in the Region of Augsburg) research platform and MONICA Augsburg (Monitoring Trends and Determinants on Cardiovascular Diseases) studies were initiated and financed by the HelmholtzZentrum München–German Research Centre for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research, and Technology and by the State of Bavaria.

PII: S0735-1097(09)02843-5

doi:10.1016/j.jacc.2009.07.034

Journal of the American College of Cardiology
Volume 54, Issue 21 , Pages 1982-1989, 17 November 2009

Article Tools

* Image Usage & Resolution