Obesity, hypertension and tobacco use associated with left ventricular remodelling and hypertrophy in South African Women: Birth to Twenty Plus Cohort

Background Left ventricular hypertrophy (LVH) is a known marker of increased risk in developing future life-threating CVD, though it is unclear how health risk factors, such as obesity, blood pressure and tobacco use, associate with left ventricular (LV) remodelling and LVH across generations of urban African populations. Methods Black female adults (n=123; age: 29-68 years) and their children (n=64; age: 4-10; 55% female) were recruited from the Birth to Twenty Plus Cohort in Soweto, South Africa. Tobacco and alcohol use, physical activity, presence of diabetes mellitus, heart disease and medication were self-reported. Height, weight, and blood pressure were measured in triplicate. Echocardiography was used to assess LV mass at end-diastole, perpendicular to the long axis of the LV and indexed to body surface area to determine LVH. Results Hypertension and obesity prevalence were 35.8% and 59.3% for adults and 45.3% and 6.3% for children. Self-reported tobacco use in adults was 22.8%. LVH prevalence was 35.8% (n=44) in adults (75% eccentric; 25% concentric), and 6.3% (n=4) in children (all eccentric). Prevalence of concentric remodelling was 15.4% (n=19) in adults and observed in one child. In adults, obesity (OR: 2.54 (1.07-6.02; p=0.02) and hypertension (3.39 (1.08-10.62; p=0.04) significantly increased the odds of LVH, specifically eccentric LVH, while concentric LVH was associated with self-reported tobacco use (OR: 4.58 (1.18-17.73; p=0.03; n=11). Although no logistic regression was run within children, of the four children LVH, three had elevated blood pressure and the child with normal blood pressure was overweight. Conclusions The association between obesity, hypertension, tobacco use and LVH in adults, and the 6% prevalence of LVH in children, calls for stronger public health efforts to control risk factors and monitor children at who are risk.