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

Hicham Skali, Amil Shah, Deepak K. Gupta, Susan Cheng, Brian Claggett, Jiankang Liu, Natalie Bello, David Aguilar, Orly Vardeny, Kunihiro Matsushita, Elizabeth Selvin, Scott Solomon

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)448-454
Number of pages7
JournalCirculation: Heart Failure
Volume8
Issue number3
DOIs
StatePublished - May 4 2015

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Heart Diseases
Atherosclerosis
Diabetes Mellitus
Heart Failure
Glycosylated Hemoglobin A
Confidence Intervals
Left Ventricular Function
Hypoglycemic Agents
Coronary Disease
Echocardiography
Cardiovascular Diseases

Keywords

  • cardiomyopathies
  • diabetes mellitus
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Skali, Hicham; Shah, Amil; Gupta, Deepak K.; Cheng, Susan; Claggett, Brian; Liu, Jiankang; Bello, Natalie; Aguilar, David; Vardeny, Orly; Matsushita, Kunihiro; Selvin, Elizabeth; Solomon, Scott.

In: Circulation: Heart Failure, Vol. 8, No. 3, 04.05.2015, p. 448-454.

Research output: Contribution to journalArticle

Skali, Hicham ; Shah, Amil ; Gupta, Deepak K. ; Cheng, Susan ; Claggett, Brian ; Liu, Jiankang ; Bello, Natalie ; Aguilar, David ; Vardeny, Orly ; Matsushita, Kunihiro ; Selvin, Elizabeth ; Solomon, Scott. / 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. In: Circulation: Heart Failure. 2015 ; Vol. 8, No. 3. pp. 448-454.
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AU - Gupta, Deepak K.

AU - Cheng, Susan

AU - Claggett, Brian

AU - Liu, Jiankang

AU - Bello, Natalie

AU - Aguilar, David

AU - Vardeny, Orly

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AB - 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.

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KW - diabetes mellitus

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