Life-course burden of health deficits associates with later-life heart size and function in the 1946 British birth cohort

AimTo study the association between the life-course accumulation of health deficits and later-life heart size and function using data from the 1946 National Survey of Heath and Development (NSHD) British birth cohort, the world’s longest running birth cohort with continuous follow-up.Methods and ResultsA multidimensional health deficit index (DI) looking at 45-health deficits was serially calculated at 4 time periods of the life-course in NSHD participants (0-16, 19-44, 45-54 and 60 to 64 years), and from these the mean and total DI for the life-course was derived (DImean, DIsum). The step change in deficit accumulation from one time period to another was also calculated. Echocardiographic data at 60-64 years provided: ejection fraction (EF), left ventricular mass indexed to body surface area (LVmassi, BSA), myocardial contraction fraction indexed to BSA (MCFi) and E/e’. Generalized linear models assessed the association between DIs and echocardiographic parameters after adjustment for sex, socio-economic position and body mass index.1,375 NSHD participants were included (46.47% male). For each single new deficit accumulated at any one of the 4 time periods of the life-course, LVmassi increased by 0.91-1.44% (pi decreased by 0.6-1.02% (ppp13.ConclusionThe accumulation of health deficits at any time period of the life-course associates with a maladaptive cardiac phenotype in older age, dominated by myocardial hypertrophy and poorer function. The burden of health deficits appears to strain the myocardium potentially leading to future cardiac dysfunction.