Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age. The CARDIA Study

Satoru Kishi, Samuel S. Gidding, Jared P. Reis, Laura A. Colangelo, Bharath Ambale Venkatesh, Anderson C. Armstrong, Akihiro Isogawa, Cora E. Lewis, Colin Wu, David R. Jacobs, Kiang Liu, Joao Lima

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood. Background: Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life. Methods: In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction. Results: The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level. Conclusions: Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.

Original languageEnglish (US)
JournalJACC: Cardiovascular Imaging
DOIs
StateAccepted/In press - Dec 22 2015

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Left Ventricular Function
Insulin Resistance
Young Adult
Coronary Vessels
Diabetes Mellitus
Ventricular Remodeling
Glucose
Glucose Intolerance
Stroke Volume
Echocardiography
Fasting
Hemoglobins
Homeostasis
Heart Failure
Obesity
Odds Ratio

Keywords

  • Diabetes mellitus
  • Echocardiography
  • Insulin resistance
  • Left ventricular function
  • Obesity
  • Speckle-tracking echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age. The CARDIA Study. / Kishi, Satoru; Gidding, Samuel S.; Reis, Jared P.; Colangelo, Laura A.; Ambale Venkatesh, Bharath; Armstrong, Anderson C.; Isogawa, Akihiro; Lewis, Cora E.; Wu, Colin; Jacobs, David R.; Liu, Kiang; Lima, Joao.

In: JACC: Cardiovascular Imaging, 22.12.2015.

Research output: Contribution to journalArticle

Kishi, Satoru ; Gidding, Samuel S. ; Reis, Jared P. ; Colangelo, Laura A. ; Ambale Venkatesh, Bharath ; Armstrong, Anderson C. ; Isogawa, Akihiro ; Lewis, Cora E. ; Wu, Colin ; Jacobs, David R. ; Liu, Kiang ; Lima, Joao. / Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age. The CARDIA Study. In: JACC: Cardiovascular Imaging. 2015.
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abstract = "Objectives: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood. Background: Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life. Methods: In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50{\%} for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction. Results: The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level. Conclusions: Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.",
keywords = "Diabetes mellitus, Echocardiography, Insulin resistance, Left ventricular function, Obesity, Speckle-tracking echocardiography",
author = "Satoru Kishi and Gidding, {Samuel S.} and Reis, {Jared P.} and Colangelo, {Laura A.} and {Ambale Venkatesh}, Bharath and Armstrong, {Anderson C.} and Akihiro Isogawa and Lewis, {Cora E.} and Colin Wu and Jacobs, {David R.} and Kiang Liu and Joao Lima",
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T1 - Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age. The CARDIA Study

AU - Kishi, Satoru

AU - Gidding, Samuel S.

AU - Reis, Jared P.

AU - Colangelo, Laura A.

AU - Ambale Venkatesh, Bharath

AU - Armstrong, Anderson C.

AU - Isogawa, Akihiro

AU - Lewis, Cora E.

AU - Wu, Colin

AU - Jacobs, David R.

AU - Liu, Kiang

AU - Lima, Joao

PY - 2015/12/22

Y1 - 2015/12/22

N2 - Objectives: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood. Background: Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life. Methods: In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction. Results: The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level. Conclusions: Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.

AB - Objectives: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood. Background: Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life. Methods: In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction. Results: The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level. Conclusions: Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.

KW - Diabetes mellitus

KW - Echocardiography

KW - Insulin resistance

KW - Left ventricular function

KW - Obesity

KW - Speckle-tracking echocardiography

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