Left ventricular mass and correlated atherosclerotic risk factors in young adolescents: report from Chin-Shan community cardiovascular study in Taiwan - ScienceDirect

Atherosclerosis

Volume 155, Issue 2, April 2001, Pages 431-437

Atherosclerosis

https://doi.org/10.1016/S0021-9150(00)00579-7 Get rights and content

Abstract

Various subclinical disease indicators can be used as an early stage marker of atherosclerosis. Left ventricular (LV) mass has been related to cardiovascular morbidity and mortality. The distribution of LV mass in Chinese is rarely studied and nothing is known about its relationships with various atherosclerotic risk factors in young teenagers, in particular, aspects of lipid profiles. We performed a community-based survey of 523 males and 555 females, aged 12–15, in Chin-Shan, a suburb area near Taipei, Taiwan. LV mass was calculated from the Penn convention. Normalized LV mass by height with power of 2.7 was defined. LV mass and normalized LV mass were significantly greater in males than in females. There were significant positive correlation coefficients between LV mass and age, blood pressure, body mass index, low density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) B, fasting insulin levels and significant negative correlation coefficients between LV mass and high density lipoprotein cholesterol (HDL-C) and Apo A1 level in both genders. Multiple linear regression models showed gender and body mass index (BMI) were important factors associated with LV mass or normalized values for adolescents. Age and systolic blood pressure were also significant predictors of LV mass, but not of normalized LV mass values. LV mass values were found to be negatively associated with HDL-C values at marginal statistically significant level. Age and BMI are the most significant factors of echocardiographic LV mass distributions in young adolescent in Taiwan. LV mass may also be associated with atherosclerotic risk factors.

Introduction

Prospective studies have recognized that high blood pressure and obesity are related to the degree of aortic atherosclerosis [1]. The clustering of atherosclerotic risk factors in early adult life is associated with cardiovascular disease in middle-aged men [2]. There are conflicts about early onset of atherosclerosis in children. As fatalities due to cardiovascular disease rarely happened in the children and young adults, it is hard to define atherosclerotic risk patterns for children in tissue studies. From the postmortem studies, the characteristics of atherosclerotic lesions in adolescents are similar to that for adults [3], [4]. Dyslipidemia, such as high low density lipoprotein cholesterol (LDL-C) and low high density lipoprotein cholesterol (HDL-C) are significantly associated with the severity of the lesion in children and early adulthood [2], [5]. Yet, it is of interest to associate dyslipidemia with left ventricular (LV) mass in the population at risk of cardiovascular diseases.

LV hypertrophy, determined by echocardiography, has been recognized as being strongly associated with cardiovascular diseases [6], [7]. The Framingham Heart Study found a six to eight-fold increased risk of cardiovascular events for individuals with LV hypertrophy in adults [8]. Previous studies had reported that, in young adolescents, LV hypertrophy was associated with higher blood pressure, obesity and genders [9]. Echocardiogrphy has been recommended as the screening tool for LV hypertrophy [10], [11], [12], [13], [14]. To the best of our knowledge, little has been documented about the relationships between lipid profiles and echocardiographic LV mass in the young population.

Morbidity and mortality from cardiovascular diseases in Taiwan are uprising, especially in coronary heart disease [15]. In clinical setting, some of atherosclerotic risk factors have developed in young adults with the advance of Taiwan's economic growth and the westernized life style. This study was designed to examine patterns of atherosclerotic risk factors, especially lipid profiles, and to interpret their associations with echocardiographically determined LV mass for young adolescents in Chin-Shan community, Taiwan.

Section snippets

Study design and population

Since 1990, we have established the Chin-Shan community cardiovascular cohort (CCCC) study and aimed to conduct the longitudinal investigation on cardiovascular diseases in Taiwan [16], [17]. In 1997, we extended a further survey to include adolescents in the only middle school from this community. Letters describing the purpose of the study were first sent to the parents of those households with children. All the 1124 students, aged 12–15, in this middle school were invited for participation.

Results

The basic anthropometric risk profiles are presented by gender in Table 1. Males and higher systolic and diastolic blood pressure, waist-to-hip ratio (WHR) and higher fasting glucose levels than females. Lipid profiles, including total cholesterol, tiglyceride, LDL-C, Apo B and fasting insulin levels were higher in females than in males. The prevalence of hyperglycemia, defined as fasting glucose greater than 126 mg/dl, was significantly higher in boys than in girls (11.8 vs. 8.0%,

Discussion

The results clearly demonstrated several atherosclerotic risk factors, such as age, sex, BMI, blood pressure and lipid profiles, on the echocardiographically determined LV mass for adolescents. To the best of our knowledge, this is the first report of the distribution and its associated factors of LV mass for community-based Chinese adolescents.

Age has a strong and persistent effect on LV mass throughout life. The associations between LV mass and gender or age have been well-established [26],

Acknowledgements

We thank cardiologists at National Taiwan University Hospital, Yu-Jenn Huang and Ching-Chu Chien for their assistance in this study. The study was partly supported by the Power Development Foundation of Taiwan Power Company and National Science Council (#NSC 83-0412-B002-064) in Taiwan.

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Standard M-mode echocardiographic measurement according to the recommendations of the American Society of Echocardiography was performed by qualified cardiologists in the 1992–1993 follow-up period [18]. The values of intra-class correlation reliability were between 0.70 and 0.85 in the various measurements and had been reported [19]. The left ventricular mass was calculated by the modified American Society of Echocardiography-cube method [20].
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