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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.

TitleCardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk In the Community study.
Publication TypeJournal Article
Year of Publication2015
AuthorsSkali H, Shah A, Gupta DK, Cheng S, Claggett B, Liu J, Bello N, Aguilar D, Vardeny O, Matsushita K, Selvin E
Secondary AuthorsSolomon S
JournalCirc Heart Fail
Volume8
Issue3
Pagination448-54
Date Published2015 May
ISSN1941-3297
KeywordsAge Factors, Aged, Aged, 80 and over, Atherosclerosis, Biomarkers, Blood Glucose, Chi-Square Distribution, Coronary Disease, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin A, Heart Failure, Humans, Hypertrophy, Left Ventricular, Hypoglycemic Agents, Linear Models, Male, Multivariate Analysis, Prediabetic State, Prevalence, Prospective Studies, Risk Assessment, Risk Factors, Sex Factors, Systole, United States, Ventricular Dysfunction, Left, Ventricular Function, Left
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.

DOI10.1161/CIRCHEARTFAILURE.114.001990
Alternate JournalCirc Heart Fail
PubMed ID25759458
PubMed Central IDPMC4439326
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
K08 HL116792 / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HC-11-08 / HC / NHLBI NIH HHS / United States
HHSN268201100005C / / PHS HHS / United States
R01 DK089174 / DK / NIDDK NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
R00-HL-107642 / HL / NHLBI NIH HHS / United States
HHSN268201100009C / / PHS HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / / PHS HHS / United States
R00 HL107642 / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / / PHS HHS / United States
HHSN268201100012C / / PHS HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / / PHS HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
T32 HL007374 / HL / NHLBI NIH HHS / United States
HHSN268201100011C / / PHS HHS / United States
5T32HL007374-34 / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
K08-HL-116792 / HL / NHLBI NIH HHS / United States
HHSN268201100006C / / PHS HHS / United States