Direct, inflammation-mediated and blood-pressure-mediated effects of total and abdominal adiposity on diastolic function: EPIPorto study

•We studied a sample of 1063 individuals from the general population.•Adiposity, especially abdominal obesity, was associated with early diastolic function.•This association was more important in men and in the younger population.•In men, adiposity induced diastolic dysfunction mainly by direct (adiposity mediated) mechanisms.•However, in women, most of the effect was indirect mainly through hypertension.

BackgroundObesity has been associated with subclinical diastolic dysfunction and increased risk of heart failure. Our aims were to evaluate the age- and sex-specific role of total and abdominal adiposity on diastolic function and to assess the direct and indirect pathophysiological mechanisms involved in this association.Methods and resultsWithin a population-based study (EPIPorto), a total of 1063 individuals aged ≥ 45 years (62% female; 62.4 ± 10.6 years) were evaluated using echocardiography, anthropometrics, electrical bioimpedance and blood tests. Diastolic function was assessed with using EAE/ASE consensus criteria.Worse diastolic function grades were associated with increased BMI, fat mass % and waist-to-height ratio (p for trend < 0.001). The inverse association between adiposity and diastolic function was stronger in men and in the younger population. In multivariate analysis, waist-to-height ratio (per cm/cm) was associated with reduced E′ velocity (adjusted β: − 14.4; 95% CI: − 21.1 to − 7.6; p < 0.001) and increased E/E′ ratio (adjusted β: 9.7, 95% CI: 5.4-10.0; p < 0.001), among men < 65 years.Both direct and indirect mechanisms were involved in the E′ velocity decrease by waist-to-height ratio in participants < 65 years. The effect was mainly direct in men (81.3%), while it was mostly indirect in women, through systolic blood pressure (50.8%) and inflammation (15.1%).ConclusionsAdiposity, especially abdominal, was associated with worse diastolic function. This association was more important in men and in the younger population. The causal mechanisms involved were sex-specific, with mostly direct effects among men and blood-pressure-mediated among women.