Impact of Diabetes on Cardiac Structure and Function

Devereux, Richard B.; Roman, Mary J.; Paranicas, Mary; O’Grady, Michael J.; Lee, Elisa T.; Welty, Thomas K.; Fabsitz, Richard R.; Robbins, David C.; Rhoades, Everett R.; Howard, Barbara V.

doi:10.1161/01.cir.101.19.2271

Cited by 833 publications

(597 citation statements)

References 33 publications

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“…2,5,9 Non-insulin-dependent diabetes mellitus has been independently associated with an increase in left ventricular mass. 33,34 In our previous study among DHCCP patients, blood glucose concentration tended to be inversely related to the presence of ECG LVH by Sokolow-Lyon criterion. 35 In the Framingham Heart Study after adjusting for BMI and other risk factors, severity of hyperglycaemia was observed to be related to left ventricular mass more strongly in women than in men.…”

Section: Discussionmentioning

confidence: 85%

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

et al. 2006

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The clinical usefulness of the Sokolow-Lyon voltage criteria in the assessment of electrocardiographic left ventricular hypertrophy (ECG LVH) is addressed. We prospectively studied 3338 women and 3330 men referred with hypertension, with an average follow-up of 11.2 years. The voltage amplitude sum SV1 þ max (RV5 or RV6) was calculated and ECG LVH was defined as a sum X3.5 mV. We adjusted survival for age, treatment status before presentation and a previous myocardial infarction or cerebrovascular accident. The risk of stroke, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality increased significantly for each quantitative 0.1 mV increase in baseline electrocardiogram (ECG) voltage, in women within the range of 1.6-3.9% and in men 1.4-3.0%. After further adjustments for race, body mass index, smoking and systolic blood pressure, increasing voltage independently predicted CVD mortality in both men and women. In women, both increasing voltage and the presence of left ventricular hypertrophy (LVH) were predictors of stroke mortality, whereas in men this risk was attenuated. In men, the adjusted association between increasing voltage and CHD mortality tended to be stronger than in women. The use of different thresholds for the two genders made little difference. For stroke and CHD mortality, the population attributable fractions associated with LVH were 15.2 and 5.4% in women and 12.8 and 8.5% in men, respectively. In conclusion, the greater the baseline ECG voltage sum, the greater the associated CVD mortality risk. Women tended to have a high risk of stroke mortality owing to LVH despite adjustments.

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Section: Discussionmentioning

confidence: 85%

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

et al. 2006

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“…4,5 Arterial stiffening occurs as a consequence of aging and is increased in the presence of risk factors for atherosclerosis such as hypertension, diabetes mellitus, hypercholesterolemia and smoking. [6][7][8] There is evidence suggesting that aortic pulse wave velocity (PWV) and wave reflections as assessed by augmentation index (AIx) are associated with an increased risk of cardiovascular disease in young and middle-aged men. 9 PWV and AIx have been found to be elevated in patients with active arteritis.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein and aortic stiffness and wave reflection in middle-aged and elderly men from the community

et al. 2007

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High plasma C-reactive protein (hs-CRP) levels and arterial stiffness are risk factors for cardiovascular diseases. Pulse wave velocity (PWV) and augmentation index (AIx) have been found to be elevated in patients with vascular inflammation, diabetes mellitus, hypertension, hypercholesterolemia and in smokers. We investigated the relation of high-sensitivity CRP (hs-CRP) with aortic stiffness in 362 men. The levels of hs-CRP were measured using a nephelometric method. Aortic PWV and AIx were assessed from carotid-femoral segment and radial artery waveforms with the use of the SphygmoCor device. In the crude model, aortic PWV increased significantly with increasing serum hs-CRP levels; PWV increased by 2.48 m/s (95% CI 1.58; 3.38) in the fifth compared to the first quintile of hs-CRP. In the adjusted model, the PWV increased by 0.84 m/s (95% CI 0.13; 1.55) in the fifth quintile compared to the first quintile (P-value was 0.02). In the crude model, AIx increased significantly with increasing serum hs-CRP levels; AIx increased by 7.17% (95% CI 3.72; 10.62) in the fifth versus the first quintile. Adjusted for confounders, AIx remained 4.57% (95% CI 1.32; 7.82) higher in the fifth compared to the first quintile (P-value for trend was o0.01). More adjustment for subclinical atherosclerosis attenuated the b-coefficient for PWV (difference 0.71 m/s (95% CI 0.01; 1.41), but not for AIx (4.60% (95% CI 1.34; 7.85)). In summary, low-grade inflammation seems to be independently related to increase of aortic artery stiffness over and above traditional risk factors and atherosclerosis.

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Section: Discussionmentioning

confidence: 99%

“…27,28 Moreover, diabetes has a negative impact on treatment-induced changes in LV structure and function in hypertensives with LVH. 29 In the Strong Heart Study, 27 which involved a wide group of American Indians, diabetic subjects had higher LVM, interventricular septum thickness, PWT and RWT in comparison with subjects without diabetes, with no difference in LV chamber size. Similar results were obtained in the HYperGEN Study, 28 in which diabetic hypertensives had higher LVM and more concentric geometry when compared with non-diabetic hypertensives (again in this study diabetics had higher LVM, interventricular septum thickness, PWT and RWT but there was no difference with regard to LV diameter).…”

Section: Discussionmentioning

confidence: 99%

“…This limits the applicability of our results to other racial or ethnic groups, but it is noteworthy that results similar to ours were obtained in American Indians participating to the Strong Heart Study. 27 We evaluated only clinic BP, whereas 24-h ambulatory BP was not assessed, and associations between echocardiographic variables and arterial stiffness or albuminuria were not tested, because these data were available only for a minority of patients. Lastly, as all our patients received antihypertensive drugs, we have to acknowledge the possible influence of the pharmacological treatment on our results.…”

Section: Study Limitationsmentioning

confidence: 99%

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Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR) 460 ml min À1 per 1.73 m 2 , dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P ¼ 0.0001), relative wall thickness (RWT) (P ¼ 0.0001) and left atrium volume index (P ¼ 0.03), when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P ¼ 0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (b 0.364; P ¼ 0.0001), GFR (beta 0.101; P ¼ 0.019), and the presence of diabetes (b 0.166; P ¼ 0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure.

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Impact of Diabetes on Cardiac Structure and Function

Cited by 833 publications

References 33 publications

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

Left ventricular hypertrophy determined by Sokolow–Lyon criteria: a different predictor in women than in men?

C-reactive protein and aortic stiffness and wave reflection in middle-aged and elderly men from the community

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

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