Increased triglyceride independently associates with premature structural and functional cardiac damage progression in asymptomatic adolescents: a 7-year longitudinal study

Abstract

Abstract Background High levels of triglyceride have been associated with poor cardiovascular health in adults. The relationships between triglyceride and early signs of vascular organ damage among adolescents and young adults are inconsistent. There is a scarcity of longitudinal evidence regarding the potentially deleterious effects of increased triglyceride on cardiac structure and function in apparently healthy youth. Purpose To investigate the longitudinal association of changes in triglyceride with structural and functional cardiac damage progression during growth from adolescence through young adulthood. Methods From the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, 1595 adolescents aged 17 years who had fasting plasma triglyceride measured at 17- and 24-year clinic visits were included. Repeated echocardiography measured LVM indexed for height2.7 (LVMI2.7), relative wall thickness (RWT), LV diastolic function from mitral E/A ratio (LVDF), and LV filling pressure from E/e´ ratio (LVFP) were available at baseline and follow-up. LVMI2.7 ≥51g/m2.7, RWT ≥0.44, LVDF<1.5, and LVFP ≥8 were categorised as LV hypertrophy, high RWT, LVD dysfunction, and high LVFP, respectively. Multivariable adjusted associations were examined using generalized linear mixed-effect models and generalized logit mixed-effect models and adjusted for sex, and time-varying covariates measured at both baseline and follow-up such as age, insulin, high-sensitivity C-reactive protein, heart rate, systolic blood pressure, glucose, fat mass, lean mass, smoking status, family history of hypertension/diabetes/high cholesterol/vascular disease, socioeconomic status, sedentary time, light physical activity, moderate to vigorous physical activity, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Results Among 1595 adolescents (mean [SD] age at baseline, 17.74 [0.38] years; 955 [59.8%] females]) median triglyceride values increased in males from 0.72 mmol/L to 0.86 mmol/L and in females from 0.74 mmol/L to 0.80 mmol/L, over 7 years. The prevalence of LV hypertrophy increased in males from 3.6% to 11.9% and in females from 1.6% to 4% over 7 years. The prevalence of LVD dysfunction increased in males from 7.8% to 16.6% and in females from 10.3% to 15.4%. In a fully adjusted model, each 1 mmol increase in triglyceride was significantly associated with higher odds of LV hypertrophy progression (odds ratio 2.89; [95% CI, 1.54 – 5.43], p<0.001), LVD dysfunction (1.98 [1.86 – 3.71], p=0.032), and high LVFP (2.19; [1.29 – 3.70], p=0.004) but not high RWT (1.45; [0.77 – 2.73], p=0.245), over 7 years. Conclusion Increased triglyceride during growth from adolescence through young adulthood was independently associated with progressive structural and functional cardiac damage in asymptomatic youth.