Cardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk In the Community study

Circ Heart Fail. 2015 May;8(3):448-54. doi: 10.1161/CIRCHEARTFAILURE.114.001990. Epub 2015 Mar 10.

Abstract

Background: Individuals with diabetes mellitus and pre-diabetes mellitus are at particularly high risk of incident heart failure or death, even after accounting for known confounders. Nevertheless, the extent of impairments in cardiac structure and function in elderly individuals with diabetes mellitus and pre-diabetes mellitus is not well known. We aimed to assess the relationship between echocardiographic measures of cardiac structure and function and dysglycemia.

Methods and results: We assessed measures of cardiac structure and function in 4419 participants without prevalent coronary heart disease or heart failure who attended the Atherosclerosis Risk In the Community (ARIC) visit 5 examination (2011-2013) and underwent transthoracic echocardiography (age, 75±6 years; 61% women, 23% black). Subjects were grouped across the dysglycemia spectrum as normal (39%), pre-diabetes mellitus (31%), or diabetes mellitus (30%) based on medical history, antidiabetic medication use, and glycated hemoglobin levels. Glycemic status was related to measures of cardiac structure and function. Worsening dysglycemia was associated with increased left ventricular mass, worse diastolic function, and subtle reduction in left ventricular systolic function (P≤0.01 for all). For every 1% higher glycated hemoglobin, left ventricular mass was higher by 3.0 g (95% confidence interval, 1.5-4.6 g), E/E' by 0.5 (95% confidence interval, 0.4-0.7), and global longitudinal strain by 0.3% (95% confidence interval, 0.2-0.4) in multivariable analyses.

Conclusions: In a large contemporary biracial cohort of elderly subjects without prevalent cardiovascular disease or heart failure, dysglycemia was associated with subtle and subclinical alterations of cardiac structure, and left ventricular systolic and diastolic function. It remains unclear whether these are sufficient to explain the heightened risk of heart failure in individuals with diabetes mellitus.

Keywords: cardiomyopathies; diabetes mellitus; echocardiography.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atherosclerosis / diagnosis
  • Atherosclerosis / epidemiology*
  • Biomarkers / blood
  • Blood Glucose / analysis*
  • Blood Glucose / drug effects
  • Chi-Square Distribution
  • Coronary Disease / diagnosis
  • Coronary Disease / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology*
  • Female
  • Glycated Hemoglobin / analysis
  • Heart Failure / diagnosis
  • Heart Failure / epidemiology
  • Humans
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / epidemiology*
  • Hypertrophy, Left Ventricular / physiopathology
  • Hypoglycemic Agents / therapeutic use
  • Linear Models
  • Male
  • Multivariate Analysis
  • Prediabetic State / blood
  • Prediabetic State / diagnosis
  • Prediabetic State / drug therapy
  • Prediabetic State / epidemiology*
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Systole
  • United States / epidemiology
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human