TY - JOUR
T1 - Echocardiographic pulmonary artery systolic pressure in the Coronary Artery Risk Development in Young Adults (CARDIA) study
T2 - Associations with race and metabolic dysregulation
AU - Brittain, Evan L.
AU - Nwabuo, Chike
AU - Xu, Meng
AU - Gupta, Deepak K.
AU - Hemnes, Anna R.
AU - Moreira, Henrique T.
AU - De Vasconcellos, Henrique Doria
AU - Terry, James G.
AU - Carr, Jeffrey J.
AU - Lima, Joao A.C.
N1 - Funding Information:
The authors would like to thank Dr Anderson Armstrong for his thoughtful review of the manuscript. This work was supported by the American Heart Association Fellow to Faculty Grant #13FTF16070002 and Gilead Sciences Research Program in Pulmonary Arterial Hypertension (Brittain), National Heart, Lung, and Blood Institute 1P0 HL108800-01A1 (Brittain, Hemnes), 1 U01 HL125212-01 (Brittain, Hemnes), National Heart, Lung, and Blood Institute K12HL109019 (Gupta). The CARDIA study was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C and HHSN268201 300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), Johns Hopkins University School of Medicine (HHSN2682 00900041C), and Vanderbilt University (HL098445). The CARDIA study is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005).
Publisher Copyright:
© 2017 The Authors.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background-The determinants of pulmonary artery systolic pressure (PASP) are not fully understood. It is unknown whether racial differences in PASP exist or if other population characteristics are associated with pulmonary pressure in humans. We examined echocardiographically estimated PASP in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a middle-aged, biracial community-based cohort. Methods and Results-At the CARDIA year-25 examination, 3469 participants underwent echocardiography, including measurement of tricuspid regurgitant jet velocity to estimate PASP. Clinical features, laboratory values, pulmonary function tests, and measurement of adipose depot volume were analyzed for association with PASP. PASP was estimated in 1311 individuals (61% female, 51% white). Older age, higher blood pressure, and higher body mass index were associated with higher PASP. Black race was associated with higher PASP after adjustment for demographics and left and right ventricular function (β 0.94, 95% CI 0.24-1.64; P=0.009), but this association was no longer significant after further adjustment for lung volume (β 0.42, 95% CI -0.68 to 0.96; P=0.74). Insulin resistance, inflammation (C-reactive protein and interleukin-6), and visceral adipose volume were independently associated with higher PASP after adjustment for relevant covariates. PASP rose with worsening diastolic function (ratio of early transmitral Doppler velocity to average mitral annular tissue Doppler velocity [E/e'] and left atrial volume index). Conclusions-In a large biracial cohort of middle-aged adults, we identified associations among black race, insulin resistance, and diastolic dysfunction with higher echocardiographically estimated PASP. Further studies are needed to examine racial differences in PASP and whether insulin resistance directly contributes to pulmonary vascular disease in humans.
AB - Background-The determinants of pulmonary artery systolic pressure (PASP) are not fully understood. It is unknown whether racial differences in PASP exist or if other population characteristics are associated with pulmonary pressure in humans. We examined echocardiographically estimated PASP in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a middle-aged, biracial community-based cohort. Methods and Results-At the CARDIA year-25 examination, 3469 participants underwent echocardiography, including measurement of tricuspid regurgitant jet velocity to estimate PASP. Clinical features, laboratory values, pulmonary function tests, and measurement of adipose depot volume were analyzed for association with PASP. PASP was estimated in 1311 individuals (61% female, 51% white). Older age, higher blood pressure, and higher body mass index were associated with higher PASP. Black race was associated with higher PASP after adjustment for demographics and left and right ventricular function (β 0.94, 95% CI 0.24-1.64; P=0.009), but this association was no longer significant after further adjustment for lung volume (β 0.42, 95% CI -0.68 to 0.96; P=0.74). Insulin resistance, inflammation (C-reactive protein and interleukin-6), and visceral adipose volume were independently associated with higher PASP after adjustment for relevant covariates. PASP rose with worsening diastolic function (ratio of early transmitral Doppler velocity to average mitral annular tissue Doppler velocity [E/e'] and left atrial volume index). Conclusions-In a large biracial cohort of middle-aged adults, we identified associations among black race, insulin resistance, and diastolic dysfunction with higher echocardiographically estimated PASP. Further studies are needed to examine racial differences in PASP and whether insulin resistance directly contributes to pulmonary vascular disease in humans.
KW - Adipose tissue
KW - Echocardiography
KW - Inflammation
KW - Metabolic syndrome
KW - Pulmonary hypertension
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U2 - 10.1161/JAHA.116.005111
DO - 10.1161/JAHA.116.005111
M3 - Article
C2 - 28360228
AN - SCOPUS:85016612683
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 4
M1 - e005111
ER -