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

• Published in: Journal of the American College of Cardiology Vol. 54; no. 21; pp. 1982 - 1989
• Main Authors: STRITZKE, Jan, PAULISTA MARKUS, Marcello Ricardo, DUDERSTADT, Stefanie, LIEB, Wolfgang, LUCHNER, Andreas, DÖRING, Angela, KEIL, Ulrich, HENSE, Hans-Werner, SCHUNKERT, Heribert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 17.11.2009; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Aged; Aging - physiology; Atrial Function, Left - physiology; Biological and medical sciences; Blood pressure; Body mass index; Cardiology; Cardiology. Vascular system; Cardiomegaly - diagnostic imaging; Cardiomegaly - epidemiology; Cardiomegaly - etiology; Cardiovascular disease; Confidence intervals; Diabetes; Disease Progression; Echocardiography; Family medical history; Female; Follow-Up Studies; Germany - epidemiology; Health risk assessment; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart attacks; Humans; Hypertension; Male; Medical sciences; Mens health; Metabolic diseases; Middle Aged; Morbidity - trends; Obesity; Obesity - complications; Obesity - epidemiology; Population; Prognosis; Prospective Studies; Risk Factors; Stroke; Studies; Womens health; Heart; Obesity; Senescence; Nutrition disorder; Trend; Cardiovascular disease; Process; Left atrium; Research; Surveillance; Risk factor; Region; Circulatory system; Cardiology; Nutritional status; Monitoring
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.07.034

This prospective study evaluated the association of obesity and hypertension with left atrial (LA) volume over 10 years. 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. 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 > or =35.7 and > or =33.7 ml/m in men and women, respectively. 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. 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.