Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study

Marshall, Lisa; Gardin, Julius M.; Lynch, James C.; Smith, Vivienne E.; Tracy, Russell P.; Savage, Peter J.; Szklo, Moysés; Ward, Beverly J.

doi:10.1016/s0002-8703(97)70245-x

Cited by 150 publications

(104 citation statements)

References 27 publications

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“…2,5 Consequently, investigators have examined the relations of lesser degrees of glucose intolerance and insulin resistance to LV structure. 8 -13 Prior studies are limited by small samples, sex-pooled analyses, and inadequate adjustment for key confounders (BP and BMI) in multivariable analyses.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function

et al. 2003

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Background-Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias. Methods and Results-We examined the relations between echocardiographic LV measurements and glucose tolerance status in 2623 Framingham Study subjects (1514 women, mean age 53 years) free of myocardial infarction and heart failure. We also evaluated the relations of insulin resistance (homeostasis model, HOMA-IR) and LV and left atrial (LA) measures within the normal and abnormal glucose tolerance categories (the latter included impaired glucose tolerance, impaired fasting glucose, and newly diagnosed diabetes). LV mass (adjusted for age, height, heart rate, and systolic blood pressure) increased across categories of worsening glucose tolerance; the trend was more striking in women (PϽ0.001) compared with men (Pϭ0.054). In subjects with normal (nϭ2022) and abnormal glucose tolerance (nϭ327), covariate-adjusted LV mass and LV wall thickness increased across HOMA-IR quartiles in women (PϽ0.001) but not men. In contrast, covariate-adjusted LA size increased with worsening glucose tolerance and across HOMA-IR quartiles in the normal and abnormal glucose tolerance groups in both sexes. Adjustment for body mass index considerably attenuated the relations of LV/LA measures and HOMA-IR, rendering them statistically nonsignificant in the normal glucose tolerance group. Conclusions-In our large community-based sample, LV mass and wall thickness increased with worsening glucose intolerance, an effect that was more striking in women compared with men. Insulin resistance was associated with increased LV mass in women alone, but this relation was largely accounted for by obesity.

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Section: Discussionmentioning

confidence: 99%

“…LV hypertrophy has been associated with diabetes mellitus and abnormal glucose tolerance in several epidemiological investigations. [2][3][4][5] Furthermore, LV hypertrophy is a feature of several endocrinopathies characterized by insulin resistance. 6,7 Consequently, several investigators 8 -13 have evaluated the relations of insulin resistance to LVM.…”

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Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function

et al. 2003

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“…8 Patients with type 2 diabetes also have increased left ventricular mass, itself an important and independent predictor of outcome, 9 compared with non-diabetic patients, even after correction for peripheral blood pressure. 10 Increased stiffness, augmenting central systolic pressure may explain this finding, and may provide one potential mechanism by which diabetes predisposes to cardiovascular disease. However, whether measurement of arterial stiffness will prove to be a better predictor of cardiovascular risk than simply assessing pulse pressure at the brachial artery remains unclear, and the results of large-scale outcome studies are awaited.…”

Section: Introductionmentioning

confidence: 99%

Arterial stiffness, hypertension and diabetes mellitus

2000

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“…For example, increased LVM increases the risk of myocardial infarction and heart failure by enhancing myocardial oxygen consumption and by impeding diastolic left ventricular compliance. Several studies have shown that deteriorating glucose tolerance is associated with increased LVM (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The mechanisms responsible for this association remain unclear, but hyperglycemia/-insulinemia and the insulin-resistant state have been implicated in the pathogenesis of increased LVM (14 -18).…”

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Left Ventricular Mass Increases With Deteriorating Glucose Tolerance, Especially in Women: Independence of Increased Arterial Stiffness or Decreased Flow-Mediated Dilation

et al. 2004

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OBJECTIVE -Type 2 diabetes and impaired glucose metabolism (IGM) are associated with an increased cardiovascular disease (CVD) risk. Increased left ventricular mass (LVM) is thought to increase CVD risk through several unfavorable cardiac changes. Type 2 diabetes and IGM are associated with increased LVM, but the underlying mechanism is unclear. We investigated the association between glucose tolerance status (GTS) and LVM and explored whether any such association could be mediated through increased arterial stiffness, impaired endothelial function, or the presence of atherosclerosis.RESEARCH DESIGN AND METHODS -We used ultrasound to measure LVM, carotid and femoral stiffness, carotid-femoral transit time, and flow-mediated vasodilation (FMD) and tonometry to estimate compliance and augmentation index. The study population (n ϭ 780) consisted of 287 individuals with normal glucose metabolism (NGM), 179 with IGM, and 314 with type 2 diabetes, and the mean age was 68.4 years.RESULTS -In women, after adjusting for age, height, BMI, and mean arterial pressure, LVM increased significantly with deteriorating GTS (LVM 157 g in NGM, 155 g in IGM, and 169 g in type 2 diabetes; P for trend Ͻ0.018). Additional adjustment for arterial stiffness, FMD, or the presence of atherosclerosis did not materially alter the results, even though these variables were significantly associated with both GTS and LVM. Indexes of hyperglycemia/-insulinemia or insulin resistance explained at most 7% of the association between GTS and LVM. In men, no statistically significant associations were observed. CONCLUSIONS -Our data expand the conceptual view of the pathogenesis of GTS-related changes in LVM because we show that the increase in LVM in women is independent of increased arterial stiffness, impaired FMD, or the presence of atherosclerosis. In addition, we show that this increase in LVM is only minimally explained by indexes of hyperglycemia/-insulinemia or insulin resistance. Our data may, in part, explain the increased CVD risk seen in women with deteriorating GTS.

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Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study

Cited by 150 publications

References 27 publications

Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function

Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function

Arterial stiffness, hypertension and diabetes mellitus

Left Ventricular Mass Increases With Deteriorating Glucose Tolerance, Especially in Women: Independence of Increased Arterial Stiffness or Decreased Flow-Mediated Dilation

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