ASSOCIATION OF CARDIOMETABOLIC DISEASE WITH SUBCLINICAL CARDIAC REMODELING IN MEN VS WOMEN IN THE FRAMINGHAM HEART STUDY

Therapeutic Area

ASCD/CVD in Women

Background

Although the prevalence of cardiometabolic disease is greater in men vs women, the relative risk of cardiovascular disease (CVD) conferred by cardiometabolic conditions is higher in women than in men. Mechanisms underlying these apparent sex differences are not well understood. In this context, we examined the sex-specific association of cardiometabolic risk factor burden with subclinical echocardiographic cardiac remodeling.

Methods

In a cross-sectional observational study, we examined whether sex modifies the association between cardiometabolic disease burden (measured as metabolic syndrome severity [MetSS] score) with echocardiographic markers of subclinical cardiac remodeling (including cardiac strain and diastolic function) using multiplicative interaction terms in multivariable linear regression models.

Results

Among 6182 Framingham Heart Study participants (54% women; mean age 51 ± 15 years), we found that sex modifies the association between MetSS score (mean 2.1 ± 1.7, range 0-5) with subclinical markers of systolic and diastolic function. Specifically, higher MetSS score was associated with worse global longitudinal strain (GLS) and E/e’ ratio in women vs men. For example, every 1-point increase in MetSS score was associated with 1.66% higher (worse) GLS in women compared with 1.18% greater GLS in men (ß 1.66, SE 0.21 in women vs ß 1.18, SE 0.22, pint 0.01). Similarly, the MetS score was more strongly associated with a higher (worse) E/e’ ratio in women vs men (ß 1.55, SE, 0.13 in women vs ß, 0.96, SE, 0.13, pint <0.001 in men).

Conclusions

We found that sex modifies the association of cardiometabolic disease burden with subclinical markers of systolic and diastolic dysfunction. Specifically, higher cardiometabolic disease burden was associated with worse GLS and E/e’ ratio in women vs men. These findings suggest that women may experience more adverse cardiac remodeling in response to risk exposures compared with men, which may explain why cardiometabolic traits confer a greater relative risk of CVD in women.