Ten-year progression of cardiovascular organ damage in midlife women and men with overweight and obesity: the FATCOR study
A Selmyte-Besuspare, H Halland, H Midtbo, G Kararigas, E Kringeland, P Methlie, R Shigdel, E GerdtsAbstract
Background
Despite evident sex-differences in susceptibility to cardiovascular (CV) organ damage, data on progression of organ damage in women and men during midlife is limited.
Purpose
To compare 10-year change in CV organ damage in women and men with overweight and obesity, including women with menopausal transition.
Methods
Data from 270 women and 176 men in the FAT associated CardiOvasculaR dysfunction was used. Menopause was taken as >1 year since last menstruation or age ≥53. Presence of left ventricular hypertrophy (LVH) by echocardiography (left ventricular mass/height2.7 (g/m2.7) > 47 in women and > 50 in men) or increased arterial stiffness defined as carotid-femoral pulse wave velocity >10 m/s was taken as CV organ damage. Women were grouped as persistently premenopausal, transitioning through menopause or persistently postmenopausal. Logistic regression analysis was used to identify factors associated with progression of CV organ damage.
Results
After 10 years, the prevalence of LVH was unchanged in persistently premenopausal women (10% vs 7%) and in men (27% vs 23%, both p>0.28). Although the prevalence of LVH numerically doubled in women transitioning through menopause (10% vs 20%, p=0.143), a significant increase was only found in the persistently post-menopausal group (15% vs 28%, p=0.012). The prevalence of increased arterial stiffness was unchanged in persistently premenopausal women (2% vs 0%), increased numerically in women transitioning through menopause (2% vs 6%), and in the persistently postmenopausal group (9% to 16%, both p>0.13), but a significant increase was observed only in men (10% vs 19%, p≤0.001). In multivariable analysis, LVH at follow-up was independently associated with obesity at baseline (OR 4.45, 95% CI 2.02-9.80, p<0.001) and higher systolic blood pressure at follow-up (OR 1.03, 95% CI 1.01-1.05, p=0.008), but not with perimenopausal transition (OR 1.89, 95% CI 0.95-3.74, p=0.069). Increased arterial stiffness at follow-up was independently associated with higher systolic blood pressure at follow-up (OR 1.04, 95% CI 1.01-1.07, p=0.013) and older age (OR 1.15, 95% CI 1.04-1.27, p=0.005), but not with perimenopausal transition (OR 0.51, 95% CI 1.11-2.27, p=0.376).
Conclusion
Progression of LVH over 10 years in midlife was particularly observed in persistently postmenopausal women, while progression of arterial stiffness was particularly found in men. Main factors of organ damage progression were obesity at baseline and higher systolic blood pressure at follow-up, pointing to the importance of controlling metabolic risk factors in midlife to preserve CV health.