Abstract P534: Sex Differences in Left Ventricular Diastolic Function and Cognitive Performance in Midlife: Evidence From the Bogalusa Heart Study

Background: Despite the growing interest in the role of isolated left ventricular (LV) diastolic dysfunction in cardiac remodeling, little is known about its association with cognitive performance in midlife, prior to the onset of dementia. Hypothesis: We hypothesized that LV diastolic dysfunction and cardiac remodeling will be associated with cognitive performance in middle-aged adults. These associations might differ by sex and race. Aim: To investigate the impact of left atrial (LA) size, LV mass, volume, systolic and diastolic function on cognition in middle-aged Black and White, men and women from a rural, community-based cohort, the Bogalusa Heart Study (BHS), in Louisiana. Methods: A total of 1,107 participants from the BHS (48.1±5.4 years, 56.7% female, 34.3% black) with echocardiography and cognitive testing were included. Cognitive performance was quantified in a global cognitive score (GCS) comprised of the z standardized sum of 7 neuropsychiatric tests. Multivariate linear regression analysis was used for the association of E/e’, LA volume index (LAVi), LV end-diastolic volume (LVEDV), mass index (LVMi) as well as ejection fraction (LVEF) with GCS adjusted for age, sex, race, systolic and diastolic blood pressure, total and HDL cholesterol, history of smoking, diabetes, and hypertension as well as education. Interactions by sex and race were tested. Results: Even after adjusting for age, sex and race, larger LAVi, LVEDV, LVMi, higher E/e’ and lower e’ were associated with poorer cognitive function (all p <0.05), but not LVEF. These associations remained significant for E/e’, e’, and LVMi after adjusting for systolic and diastolic blood pressure, total and HDL cholesterol, history of smoking, diabetes, hypertension, as well as education. There was no significant race interaction. In contrast, the association of E/e’ with GCS was significantly stronger (standardized β coefficient =-0.20; p <0.01) in middle-aged women, but not in middle-aged men (standardized β coefficient =-0.04; p <0.36; p interaction=0.02). Conclusion: LV diastolic function is more closely associated with mid-life cognition than systolic function, and the association is present among middle aged women but not men.