Author + information
- Received March 25, 2009
- Accepted July 12, 2009
- Published online November 17, 2009.
- Jan Stritzke, MD*,
- Marcello Ricardo Paulista Markus, MD*,†,‡,
- Stefanie Duderstadt, MD*,
- Wolfgang Lieb, MD*,
- Andreas Luchner, MD§,
- Angela Döring, MD∥,
- Ulrich Keil, MD‡,
- Hans-Werner Hense, MD‡,
- Heribert Schunkert, MD*,* (, )
- MONICA/KORA Investigators
- ↵*Reprint requests and correspondence:
Prof. Dr. Heribert Schunkert, Universität zu Lübeck, Medizinische Klinik II, D-23538 Lübeck, Germany
Objectives This prospective study evaluated the association of obesity and hypertension with left atrial (LA) volume over 10 years.
Background Although left atrial enlargement (LAE) is an independent risk factor for atrial fibrillation, stroke, and death, little information is available about determinants of LA size in the general population.
Methods Participants (1,212 men and women, age 25 to 74 years) originated from a sex- and age-stratified random sample of German residents of the Augsburg area (MONICA S3). Left atrial volume was determined by standardized echocardiography at baseline and again after 10 years. Left atrial volume was indexed to body height (iLA). Left atrial enlargement was defined as iLA ≥35.7 and ≥33.7 ml/m in men and women, respectively.
Results At baseline, the prevalence of LAE was 9.8%. Both obesity and hypertension were independent predictors of LAE, obesity (odds ratio [OR]: 2.4; p < 0.001) being numerically stronger than hypertension (OR: 2.2; p < 0.001). Adjusted mean values for iLA were significantly lower in normal-weight hypertensive patients (25.4 ml/m) than in obese normotensive individuals (27.3 ml/m; p = 0.016). The highest iLA was found in the obese hypertensive subgroup (30.0 ml/m; p < 0.001 vs. all other groups). This group also presented with the highest increase in iLA (+6.0 ml/m) and the highest incidence (31.6%) of LAE upon follow-up.
Conclusions In the general population, obesity appears to be the most important risk factor for LAE. Given the increasing prevalence of obesity, early interventions, especially in young obese individuals, are essential to prevent premature onset of cardiac remodeling at the atrial level.
The MONICA Augsburg study was initiated by Dr. Keil and colleagues. The KORA Group consists of H. E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John, and their coworkers who are responsible for the design and conduct of the KORA studies. This work was supported by the Kompetenznetz Herzinsuffizienz (German Heart Failure Network) funded by the Federal Ministry of Education and Research, FKZ 01GI0205; the Deutsche Forschungsgemeinschaft (Schu 672/9-1, Schu 672/10-1, and Schu 672/12-1); the Bundesministerium für Forschung und Technologie (to Drs. Döring, Hense, and Schunkert); the Medical Faculty, University of Lübeck (to Dr. Stritzke; A39-2005); and the European-Union–sponsored project Cardiogenics (LSH-2005-037593). The KORA (Cooperative Research in the Region of Augsburg) research platform and MONICA Augsburg (Monitoring Trends and Determinants on Cardiovascular Diseases) studies were initiated and financed by the HelmholtzZentrum München–German Research Centre for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research, and Technology and by the State of Bavaria.
- Received March 25, 2009.
- Accepted July 12, 2009.
- American College of Cardiology Foundation