CARDIA: Prevalence and Sociodemographic predictors of Pulmonary Hypertension in Young Adults

1
CARDIA Prevalence and Socio-demographic
predictors of Pulmonary Hypertension in Young
Adults

• Swathy Kolli, M.D
• Maya Guglin, M.D, PhD

2
Introduction

• Definition Mean pulmonary artery pressure
  greater than 25 mm Hg
• Echocardiography Right ventricular systolic
  pressure greater than 36 mm Hg
• Prognosis is dependent on underlying etiology,
  but in general poor

doi10.1016/j.ehj.2004.09.014
3
Introduction

• Studies of pulmonary hypertension in normal
  subjects / general population are limited
• Massachusetts general hospital -3970 subjects
  mean age 32.9 yrs (1-89 years)
• PASP was independently associated with age, BMI,
  male sex, posterior wall thickness and LVEF
• 5 of subjects with BMI gt30 kg/m2 had PASP gt 40
  mmHg
• Limitations

Circulation. 20011042797-2802
4
Introduction

• In young adults 2003-2004 (20-39 yrs)
• Obesity 28.5
• Overweight 57

JAMA. 2006295(13)1549-1555
5
Objective

• What is the prevalence of pulmonary hypertension
  in healthy young adults?
• What are the clinical correlates of pulmonary
  hypertension in this population?
• Is obesity/overweight a significant correlate in
  this age group?

6
CARDIA Study design

• CARDIA (Coronary Artery Risk Development in Young
  Adults) is a longitudinal study of a cohort of
  5115 black and white men and women aged 18-30
  years at their initial examination in 1985-1986
• Balanced subgroups of race, gender and education
  in Birmingham, AL Chicago, IL Minneapolis, MN
  and Oakland, CA
• Seven examinations to date

7
CARDIA Study design

• Socio-demographic
• Clinical
• Laboratory
• Physical activity
• ECHO (Year 5 and 10)

8
CARDIA Current study

• Limited data set provided by NHLBI was used
• Year 5 data was analyzed in a cross sectional
  manner
• Outcome variable Pulmonary artery systolic
  pressure evaluated by ECHO RV outflow tract
  velocity

Circulation. 1983 Aug68(2)302-9
9
Pulmonary artery acceleration time

• Time in msec from onset of ejection to
  peak systolic
• velocity
• Normal value gt110 msec
• Decreases with
• increasing pulmonary pressures
• Acceleration timelt 70
• msec is associated
• with PASP of 70 mm
• Hg

10
CARDIA Current study

• Independent/Predictor variables
• Demographic age, race, gender, BMI
• Physical physical activity (calculated based on
  a questionnaire and expressed in exercise units)
• Social education, family income, smoking status,
  alcohol consumption
• Clinical h/o HTN, DM, heart problem, kidney
  problem, high cholesterol

11
CARDIA Statistical analysis

• Statistical analysis
• SAS software
• Linear regression, Ordinal logistic regression

12
CARDIA Results

• Final sample size included 4171 study subjects
• Mean age 24.9 yrs (18-30)
• BMI
• lt25.0 - 52
• 25.0 - 29.9- 28.7
• 30.0 - 19.3

13
CARDIA Results

• Prevalence of severe pulmonary hypertension
  (DPAAT 70 msec) was 1 and mild to moderate
  pulmonary hypertension (DPAAT 109.9-70.01 msec)
  was 14

14
CARDIA Linear regression
15
CARDIA Results

• Multivariate analysis using ordinal logistic
  regression
• Male gender
• Physical activity
• Body mass index
• Smoking status

16
CARDIA Results
17
CARDIA Conclusion

• In young adults, the prevalence of pulmonary
  hypertension estimated by doppler pulmonary
  artery acceleration time is high (15)
• Clinical correlates of pulmonary hypertension
  include age, obesity, male gender, smoking, and
  low physical activity

18
CARDIA Limitations

• Study design
• Doppler pulmonary artery acceleration time

19

• Thank you