Cumulative cardiovascular risk factor burden is independently associated with impaired global longitudinal strain in individuals with preserved ejection fraction: a Vietnamese cross-sectional study

Global longitudinal strain (GLS) and diastolic dysfunction (DD) are sensitive markers of early myocardial remodeling in patients with cardiovascular risk factors (CRFs). This study aimed to evaluate the association of GLS and DD with the burden of CRFs. This cross-sectional study included 345 patients without known cardiovascular disease who underwent transthoracic echocardiography. Participants were stratified according to the number of CRFs (0, 1, 2, or ≥ 3), including hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease and smoking. Obesity was evaluated as a covariate in regression analyses. Logistic regression was performed to identify independent predictors of abnormal GLS and DD. GLS progressively worsened with increasing CRF burden, from − 21.1% in patients without CRFs to − 17.1% in those with ≥ 3 CRFs (p for trend < 0.001). In univariate analysis, patients with ≥ 3 CRFs were significantly more prevalent in the abnormal GLS group compared with the normal GLS group (38.1% vs. 3.1%, p = 0.001). Multivariate analysis demonstrated that male sex (aOR 4.22, 95% CI 1.22–14.66; p = 0.023), obesity grade II (aOR 6.29, 95% CI 1.22–32.42; p = 0.028), and the presence of ≥ 3 CRFs (aOR 6.18, 95% CI 1.06–35.98; p = 0.043) were independent predictors of abnormal GLS. The prevalence of DD increased from 9.3% in patients without CRFs to 61.1% in those with ≥ 3 CRFs (p for trend < 0.001). However, in multivariate analysis, only age ≥ 60 years (aOR 5.80, 95% CI 2.80–12.01; p = 0.001) and systolic blood pressure (aOR 1.03, 95% CI 1.01–1.05; p = 0.001) were independently associated with DD, whereas CRF burden was not. GLS deteriorates progressively with increasing CRF burden, even in individuals without overt heart disease. While DD was primarily driven by age and systolic blood pressure, impaired GLS reflected the cumulative burden of CRFs. These findings support GLS as a sensitive tool for early detection of subclinical myocardial dysfunction in individuals with multiple CRFs.