Gender differences in the relationship between age-related carotid intima-media thickness and cardiac diastolic function in a healthy Chinese population

Background: Ventricular-arterial coupling is a key determinant of cardiovascular performance. However, little is known about the gender differences in ventricular-arterial interactions in the healthy Chinese population.

Objective: To identify gender differences in the association between carotid intima-media thickness (CIMT) and cardiac diastolic function in healthy Chinese individuals.

Methods and results: We examined 852 healthy participants (aged 30-98 years, 46% men) in 3 northern China cities with the use of M-mode ultrasonography to analyze CIMT and cardiac structure and function. Cardiac function was measured by determining the ratio of early-diastolic peak flow velocity (E) and late-diastolic peak flow velocity (A), as well as the deceleration time of the early mitral velocity (MV-DT). Cardiac dysfunction was defined as E/A values <25th percentile (E/A <0.78 for men and <0.79 for women), left atrial volume (LAV) values >75th percentile (LAV >34.9 mL for men and >32.2 mL for women), and MV-DT values >75th percentile (MV-DT >210 ms for men and >195 ms for women). CIMT, E/A, LAV, and MV-DT were significantly correlated with age in both men (CIMT: r = 0.418, P < .01; E/A: r = -0.325, P < .01, LAV: r = 0.123, P < .05; MV-DT: r = 0.175, P < .01) and women (CIMT: r = 0.429, P < .01; E/A: r = -0.423, P < .01; LAV: r = 0.180, P < .01; MV-DT: r = 0.174, P < .01). Interestingly, left ventricular ejection fraction (LVEF) was not significantly correlated with age in either gender. CIMT was significantly associated with a lower E/A in an unadjusted model in tertiles II and III. The odds ratios (95% confidence interval [CI]) for men were 2.428 (1.36-4.335) and 3.017 (1.674-5.437), respectively. However, this association disappeared with age adjustment. The odds ratios (95% CI) for women were 3.298 (1.742-6.246) and 6.002 (3.202-11.251), respectively, and these were still significant after adjustments for all other variables, including age, blood pressure, blood lipid, and inflammatory markers (tertile II: 3.031, 95% CI 1.228-7.48; tertile III: 3.224, 95% CI 1.308-7.946). A higher MV-DT was significantly correlated with higher CIMT only in an unadjusted model for women, and this association was lost with age adjustment. There was no significant association between CIMT and higher LAV values.

Conclusions: Age-related increases in CIMT were correlated with a decline in cardiac diastolic function only in women, which may contribute to the higher incidence of heart failure with preserved ejection fraction.