Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome

Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height ^2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10–20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E′); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min–max]): DS had lower height (cm) (144.5 [116.7–170.3] vs. 163.3 [134.8–186.7]; p < 0.0001); LBM (kg) (33.48 [14.5–62.3] vs 41.8 [18.07–72.46], p < 0.0001); and LVM (g) (68.3 [32.1–135] vs 94.0 [43.9–164.6], p < 0.0001); similar EF (%) (65 [54–77] vs 64 [53–77], p = 0.59); and higher E/E′ (8.41 [5.54–21.4] vs 5.81 [3.44–9.56], p < 0.0001). In height ^2.7 -adjusted models, LVM was lower in DS (β = − 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = − 15.1, p < 0.0001), a finding not explained by MVPA. E/E′ remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height ^2.7 , the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown. Clinical Trial Registration: NCT01821300.