Objectives. To examine the relation between left ventricular (LV) diastolic function and glucose metabolism in individuals without previously diagnosed diabetes mellitus. Design. A cross-sectional population-based study. Setting. A university hospital. Subjects. Thirty-five men and women 56-58 years of age without previously diagnosed diabetes or heart disease. Main outcome measures. Left ventricular diastolic function assessed by pulsed Doppler tissue imaging and its relation to fasting plasma glucose, glucose postload and glycated haemoglobin. LV diastolic function was determined by measuring early diastolic filling peak velocity (E m wave cm s )1 ), late diastolic filling peak velocity (A m wave cm s )1 ) and their ratio E m /A m . Results. Peak E m velocity, peak A m velocity and their ratio E m /A m correlated with fasting plasma glucose (r ¼ -0.42, P ¼ 0.01; r ¼ 0.47, P ¼ 0.04 and r ¼ )0.53, P ¼ 0.001, respectively). There was a correlation between peak E m velocity, the ratio of E m /A m and glycated haemoglobin. LV diastolic function was also related to glucose postload. Conclusions. Left ventricular diastolic function is related to concentrations of fasting plasma glucose, glucose postload and glycated haemoglobin even below the threshold of diabetes. This indicates that glucose concentrations already in the upper end of the normal range has negative impact on cardiac function.

Left ventricular function in elite runners and controls was compared by means of nuclear angiocardiography. Fifteen middle- or long-distance runners and a control group of 10 sedentary to moderately physically active subjects were studied at rest and during semi-sitting incremental exercise. Ejection fraction was higher in the runners than the controls both at rest and during exercise. At the transition from rest to exercise left ventricular end-diastolic volume initially increased similarly in runners and controls by an average of 14 and 12%, respectively, with an increase in stroke volume by approximately 25 and 23%. The parallel increase in stroke volume and left ventricular end-diastolic volume could at least partly be because of the Frank-Starling mechanism. With increasing workloads, left ventricular end-diastolic volume and ejection fraction remained fairly constant, resulting in an unchanged stroke volume from the lowest to the highest exercise intensity. This was in the runners accomplished by a 41% increase in peak filling rate and a 38% increase in peak emptying rate with similar changes observed in the controls. This has to be due to increased myocardial contractility paralleling the systolic shortening with increasing heart rate. We conclude that endurance-trained athletes have a better systolic function expressed as higher ejection fraction both at rest and during exercise than untrained subjects reflecting an enhanced myocardial contractility contributing to the maintenance of a large stroke volume during exercise. The regulatory mechanisms however, appear to be similar for athletes and healthy controls.

Vascular function correlates with risk factors for cardiovascular disease in a healthy population of 3 5-year-old subjects. Intern Med 1997; 241: 507-13.Objective. To investigate whether, in a healthy, randomly selected population of 35-year-old men and women, there is a relation between vascular function and conventional risk factors for cardiovascular disease such as gender, smoking, elevated blood-lipids, high blood pressure and heredity for cardiovascular disease, and to blood glucose. Design. Basal brachial artery diameter was measured. Endothelial function was measured as flow mediated dilation (FMD) in response to reactive hyperaemia. The nonendothelial dependent dilation was measured after sublingual nitro-glycerine (NTG). Setting. A research centre of general medicine and a university hospital.Subjects. One hundred men and 100 women all 35 years old, were invited by letter. Sixty-six of the 92 men (72 %) living in the community and 74 of the 88 women (84%) participated. Results. Gender had the largest innuence on FMDand NTG induced arterial dilation, probably reflecting the larger vessel diameters in the men as FMD and NTG induced dilation is inversely related to basal vessel size (r = -0.55, P < 0.001 and r = -0.40, P < 0.001). In women basal vessel diameter was positively correlated to blood glucose (r = 0.35, P = 0.009) and BMI (r = 0.34, P = 0.012) and negatively correlated to HDL cholesterol (r = -0.43, P = 0.001). FMD and NTG induced arterial dilation correlated with a combined risk factor score ( r = -0.32, P = 0.019 and r = -0.31, P = 0.024). The men with the highest risk factor scores had larger vessel size and higher blood flow at rest compared to men without risk factors (4.8 kO.6 mm, 240f 84 mL min-' and4.0+0.8 111111,139 k 72 mL min-', respectively, P = 0.014 and P = 0.016). FMD or NTG induced dilation did not correlate to any of the risk factors in men.Conclusions. There are correlations between vascular reactivity and risk factors for MD in women and correlations between vessel diameter and risk factors for MD in both men and women already in a healthy population 3 5-year-old subjects. Further studies are needed to determine if the vessel diameter in itself, in a healthy population, is a sign of attenuated endothelial function.

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