Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function

Abstract

Background We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of U.S. Hispanics. Methods and Results ECHO-SOL, an echocardiographic ancillary study of The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), enrolled 1,818 Hispanic/Latino men (43%) and women (57%) age≥45 years (mean=56). Glucose intolerance was defined as: i) Prediabetes: HbA1c≥5.7 and <6.5%; ii) Diabetes: fasting plasma glucose≥126 mg/dL, 2-h postload glucose≥200 mg/dL, HbA1c≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes (UD) was defined as HbA1c≥7.0%. Insulin resistance was defined using HOMA-IR. Echocardiography exams assessed left ventricular (LV) structure and systolic/diastolic function. Multivariable linear and logistic regression models were utilized. Prediabetes prevalence was 42% and diabetes prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased LV posterior wall and inter-ventricular septal and relative wall thicknesses (RWT), all p<0.05; reduced ejection fraction (p<0.01); stroke and end diastolic volumes (both p-values<0.001); decreased peak e' velocity (lateral and septal p-values<0.001), increased E/e' ratio (lateral and septal p-values<0.01). The odds ratios(95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes (vs. diabetes-free) respectively, were 1.36(0.96-1.9) and 1.90(1.3-2.8), p=0.006. Results were consistent for uncontrolled diabetes vs. diabetes. HOMA-IR was associated with increased E/e' (p<0.001), and greater RWT, septal thickness (both p<0.05); lower stroke volume (p<0.0001); and lower peak lateral and septal e' velocities (both p<0.01). Conclusions Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even prior to diabetes development.

Relation of Insulin Resistance to Longitudinal Changes in Left Ventricular Structure and Function in a General Population

“…Previous cross‐sectional large‐scale community‐based studies have demonstrated an independent association of subclinical LV remodeling and dysfunction with insulin resistance 10, 11, 12, 13, 14, 15. On the other hand, population data on the longitudinal changes of LV structure and function in relation to insulin resistance are sparse.…”

Left ventricular diastolic dysfunction in diabetes mellitus and the therapeutic role of exercise training

“…Duration of diabetes, age and abnormally elevated levels of Hb1AC were independently correlated with LVDD in several studies (15,21,27,28,29). An independent relationship between LVDD and BMI was also reported (18,22,28). Other studies found no independent correlation between alteration of diastolic function and poor glycemic control (19,23).…”

“…Holzman et al reported a continuous relationship between values of fasting plasma glucose and HbA1C and LVDD in a middleaged non-diabetic population, suggesting early development of LV alterations even in prediabetic states (17). In a large study, which investigated the relationship between glucose homeostasis and LV structure and systolic/diastolic function, glucose intolerance and insulin resistance were associated with measures of diastolic dysfunction even in stages preceding the development of DM (18). In newly diagnosed (within 1 month) normotensive type 2 DM subjects aged between 30-60 years, LVDD was present in 41% of patients.…”

“…Hyperglycemia may activate the renin-angiotensin system, which stimulates oxidative stress, apoptosis and necrosis, with an increase in interstitial fibrosis (40). Both hyperglycemia and hyperinsulimenia may stimulate myocyte hypertrophy, which is accompanied, during evolution, by LVDD (18,41). Cardiac microvascular disease in DM reduces coronary flow reserve, in the absence of atherosclerosis of epicardial coronary arteries (42), causing myocardial cell damage and subsequently, myocardial fibrosis (43).…”

P32 Assessment of left ventricular using speckle tracking echocardiography and its relationship with insulin resistance in non-diabetic patients with SLE

“…1 Claudia Mendoza-Pinto, 1 Pamela Munguía-Realpozo, 2 Liliana Aquino, 1 Adalberto Ramírez-Hernández, 2 Roberto Berra-Romani, 1 Aurelio López-Colombo, 1 Mario García-Carrasco. Background/Purpose Insulin resistance (IR), which adversely impacts left ventricular (LV) remodeling and function in middle-aged patients.…”