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CLINICAL RESEARCH: CARDIOVASCULAR RISK

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^_*, Marcello Ricardo Paulista Markus, MD^_*,,, Stefanie Duderstadt, MD^_*, Wolfgang Lieb, MD^_*, Andreas Luchner, MD, Angela Döring, MD^||, Ulrich Keil, MD, Hans-Werner Hense, MD, Heribert Schunkert, MD^_*,_* for the MONICA/KORA Investigators

^_* 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
Department of Internal Medicine II, University of Regensburg, Regensburg, Germany
^|| HelmholtzZentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany

Manuscript received March 25, 2009; accepted July 12, 2009.

^_* Reprint requests and correspondence: Prof. Dr. Heribert Schunkert, Universität zu Lübeck, Medizinische Klinik II, D-23538 Lübeck, Germany (Email: heribert.schunkert{at}uk-sh.de).

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

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