Subclinical left ventricular diastolic dysfunction and incident type 2 diabetes risk: the Korean Genome and Epidemiology Study

Background Myocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS). Methods We selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18–93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/“double product” of SBP × heart rate (HR), as an estimate of O 2 consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi). Results Linear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001). Conclusions Severity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians. Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134 , Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988 Electronic supplementary material The online version of this article (10.1186/s12933-019-0862-9) contains supplementary material, which is available to authorized users.

Section: Discussionsupporting

confidence: 87%

Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort

Mancusi

Simone

Best

et al. 2019

“…It is believed that the mechanism of increased LVM is related to microvascular disease, inflammation, obesity, elevated oxidative stress, increased insulin resistance, myocardial fibrosis, left ventricular remodeling, and other conditions [ 7 – 9 ]. Meanwhile, as increased LVM and impaired diastolic dysfunction are believed to impair glucose tolerance, poor blood glucose management and increased LVM seem to closely correlate with each other [ 36 ]. High LVM is a strong predictive factor in the occurrence of cardiovascular disease beginning with heart failure and progressing to death [ 10 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of oral antidiabetic drugs on left ventricular mass in patients with type 2 diabetes mellitus: a network meta-analysis

Ida

Kaneko

Murata

2018

BackgroundWe used a network meta-analysis of randomized controlled trials (RCTs) to comparatively examine the effects of oral antidiabetic drugs (OADs) on left ventricular mass (LVM) in patients with type 2 diabetes.MethodsDocument searches were implemented using Medline, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. We decided to include RCTs that evaluated the impact of LVM using the administration of OADs to patients with type 2 diabetes. The outcome evaluations used standardized mean difference (SMD) and 95% confidence intervals (CIs). We then performed a comparative examination of LVM related to the administration of OADs using random effects network meta-analysis.ResultsThe document search found 11 RCTs (1410 people) that satisfied the eligibility criteria for this study, and these RCTs were incorporated into the network meta-analysis. The only medication that significantly reduced LVM compared to a placebo was gliclazide (SMD, −1.09; 95% CI, −1.62 to − 0.57). Further, when comparing the impact on LVM between OADs, only gliclazide significantly reduced LVM compared to other OADs (glyburide, voglibose, metformin, pioglitazone, rosiglitazone, and sitagliptin).ConclusionsIn the present study, gliclazide was the only medication that significantly reduced LVM in patients with type 2 diabetes. When considered from the perspective of causing heart failure and preventing recurrence, it is possible that the use of gliclazide in patients with type 2 diabetes will provide multiple benefits.

“…Only one study, published in March 2017, have investigated the prognostic value of myocardial indices derived from echocardiography with regards to the development of DM in the general population [ 9 ]. However, this study employed multivariable logistic regression and not survival analysis to assess the predictive value of echocardiography, and the general population was set in Korea [ 9 ], making the results not directly applicable to Caucasians taking into account that ethnicity in itself is a significant risk factor for DM, and that ethnicity modifies the relationship between several risk factors and DM [ 11 , 12 ]. Thus, this study sought to determine the prognostic role of echocardiography in predicting incident DM in a general population of European origin.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular concentric geometry predicts incident diabetes mellitus independent of established risk factors in the general population: the Copenhagen City Heart Study

Modin

Møgelvang

Jørgensen

et al. 2019

BackgroundSubtle impairments in left ventricular (LV) function and geometry are common findings in individuals with diabetes. However, whether these impairments precede the development of diabetes mellitus (DM) is not entirely clear.MethodsEchocardiograms from 1710 individuals from the general population free of prevalent diabetes mellitus were analyzed. Left ventricular (LV) concentric geometry was defined as either LV concentric remodeling or LV concentric hypertrophy as directed in contemporary guidelines. The severity of LV concentricity was assessed by relative wall thickness (RWT) calculated as posterior wall thickness (PWT) indexed to left ventricular internal diameter at end diastole (LVIDd) (RWT = 2 * PWT/LVIDd). End-point was incident DM.ResultsMedian follow-up time was 12.6 years (IQR: 12.0–12.8 years). Follow-up was a 100%. A total of 55 participants (3.3%) developed DM during follow-up. At baseline, the prevalence of a concentric LV geometric pattern was significantly higher (41.8% vs 20.3%, p < 0.001) in individuals who developed DM during follow-up. In a final multivariable model adjusting for established DM risk factors including HbA1c, BMI and plasma glucose, LV concentric geometry and RWT remained significantly associated with incident DM (LV concentric geometry: HR 1.99, 95% CI 1.11–3.57, p = 0.021) (RWT: HR 1.41, 95% CI 1.06–1.86, p = 0.017, per 0.1 increase). This association remained despite adjustment for established risk factors for DM.ConclusionAltered LV geometry may precede the development of DM. LV concentric geometry determined by echocardiography and the severity of LV concentricity evaluated as RWT are associated with incident DM in the general population.Electronic supplementary materialThe online version of this article (10.1186/s12933-019-0842-0) contains supplementary material, which is available to authorized users.