Abstract
BackgroundEarly alterations in the cardiovascular structure and function may change normal body water distribution. The resulting fluid shifts may thus serve as an early marker for cardiovascular disease. However, studies examining this in healthy populations are absent.ObjectiveThis study examined the association between the proportion of total body water that is extracellular water and subsequent development of non-fatal or fatal cardiovascular disease in a healthy population.MethodBioelectrical impedance spectroscopy is an easy-to-use, non-invasive and relatively inexpensive technique to evaluate changes in body water distribution. A random subset (n = 2120) of Danes aged 41-71 years, examined in 1993–1994 for body water distribution by bioelectrical impedance spectroscopy was included. Cox-proportional hazard models and linear splines were performed. The ratio between resistance estimates from an infinite-frequency and from no-frequency (R∞/R0) was used as a surrogate measure of ratio between extracellular water and total body water. The outcome was 13.5 years of follow-up for cardiovascular morbidity and mortality.ResultsA high proportion of total body water that is extracellular water was associated with increased risk of incident cardiovascular disease. A threshold effect was evident, with greatly increased risk of cardiovascular morbidity and mortality above R∞/R0 = 0.68. Below the threshold there seemed to be no additional benefit of having a low ratio.ConclusionOur findings suggest that non-clinically evident oedema, measured as an increased proportion of total body water that is extracellular, above a threshold of 0.68, may be an early marker of pre-clinical cardiovascular disease. This simple, safe, cheap and easily obtainable measure of R∞/R0 from bioelectrical impedance may help the early identification of these otherwise clinically healthy individuals who are at an increased risk of future cardiovascular disease. However, more studies are needed before it can be concluded that bioelectrical impedance spectroscopy improves clinical risk prediction.
Highlights
As body water distribution may change already in the very early phases during disease development, the possibility of measuring such early fluid shifts may be an attractive marker of preclinical disease
A high proportion of total body water that is extracellular water was associated with increased risk of incident cardiovascular disease
Our findings suggest that non-clinically evident oedema, measured as an increased proportion of total body water that is extracellular, above a threshold of 0.68, may be an early marker of pre-clinical cardiovascular disease
Summary
As body water distribution may change already in the very early phases during disease development, the possibility of measuring such early fluid shifts may be an attractive marker of preclinical disease. A number of studies have investigated the association between various measures of water distribution and health outcomes in different patient groups. Two studies investigating dengue virus infection in children or patients with suspected bacteraemia found an expansion of extracellular water (ECW) to be correlated with subsequent increased disease severity and mortality. These studies all found an enlarged ECW proportion to be associated with later disease severity and premature death in a variety of sick populations [11,12]. The resulting fluid shifts may serve as an early marker for cardiovascular disease Studies examining this in healthy populations are absent
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