Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

Abstract

BackgroundRecent analyses in a registry of hypertensive patients suggested that preceding left ventricular (LV) hypertrophy (LVH) and/or carotid atherosclerosis are associated with incident type 2 diabetes, independent of confounders. We assess the relation between prevalent cardio-renal target organ damage (TOD) and subsequent incident type 2 diabetes in a population-based study with high prevalence of obesity.MethodsWe selected 2887 non-diabetic participants from two cohorts of the Strong Heart Study (SHS). Clinical exam, laboratory tests and echocardiograms were performed. Adjudicated TODs were LVH, left atrium (LA) dilatation, and high urine albumin/creatinine ratio (UACR). Multivariable logistic regression models were used to identify variables responsible for the association between initial TODs and incident diabetes at 4-year follow-up (FU).ResultsAfter 4 years, 297 new cases of diabetes (10%) were identified, 216 of whom exhibited baseline impaired fasting glucose (IFG, 73%, p < 0.0001). Participants developing type 2 diabetes exhibited higher inflammatory markers, fat-free mass and adipose mass and higher prevalence of initial LVH and LA dilatation than those without (both p < 0.04). In multivariable logistic regression, controlling for age, sex, family relatedness, presence of arterial hypertension and IFG, all three indicators of TOD predicted incident diabetes (all p < 0.01). However, the effects of TOD was offset when body fat and inflammatory markers were introduced into the model.ConclusionsIn this population-based study with high prevalence of obesity, TOD precedes clinical appearance of type 2 diabetes and is related to the preceding metabolic status, body composition and inflammatory status. Trial registration 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

Diagnostic accuracy of left atrial remodelling and natriuretic peptide levels for preclinical heart failure

“…28 The thin-walled structure makes LA particularly vulnerable to volume and pressure-load conditions from long-standing elevated LV filling pressure, resulting in chamber dilation or geometric alterations with greater susceptibility for AF. 33 In fact, the Cardiovascular Health Study reported that LA may actually remodel more severely from anteroposterior direction with HF. 19 Owing to the complex geometry, it has been proposed that LAD may not enlarge equally as atrial remodelling progresses, which makes precise quantification of LA size clinically challenging.…”

“…18 Our data showed a significant difference between guideline-defined 'normal' and 'DD' groups (30.9 vs. 36.5 mm for all participants, P < 0.001) in both sexes, which challenges the traditional concept that LAD may be neither sensitive enough nor clinically feasible for assessment of LA remodelling in daily practice. 33,35 This may be partly explained by the fact that LAD assessment is a relatively robust, simple measure with potentially higher reproducibility. Our data also suggested the potential use of LAD (34 mm) as useful threshold in identifying DD with relatively high accuracy (AUROC: 77%; sensitivity/specificity: 74/68.8%; and NPV: >95%) and relatively high specificity (86.7%) in identifying LA enlargement (>34 mL/m 2 ; LAD: 37 mm) with good PPV (Table 3), indicating the potential feasibility in 'labelling' Stage B HF and help establish the clinical diagnosis of HFpEF recommended by most updated ESC HF guideline criteria.…”

“…32 In the Strong Heart Study, LAD was used as a surrogate of target organ damage for cardiovascular events and diabetes incidence. 33 In fact, the Cardiovascular Health Study reported that LA may actually remodel more severely from anteroposterior direction with HF. 34 On the other hand, Armstrong et al 35 (CARDIA study) reported that LAD may be as useful as LAVs in predicting cardiovascular outcomes in a relatively healthy population.…”

Cardiac Ion Channel Regulation in Obesity and the Metabolic Syndrome: Relevance to Long QT Syndrome and Atrial Fibrillation

“…Hyperglycemia (Gateva et al, 2017), and diabetes (de Simone et al, 2017) are also highly associated with obesity. However, it is currently unknown whether the molecular changes of cardiac ion channels in diabetic patients without obesity recapitulate that in obesity.…”

Gender characteristics of carbohydrate and lipid metabolism and vaspin levels in hypertensive patients with obesity

“…Visceral adipose tissue synthesizes and secretes a huge amount of hormonally active substances that determines the development of eating disorders, IR and impaired glucose metabolism with the development of diabetes, AH and LV hypertrophy, dyslipidemia, microalbuminuria, hypercoagulation syndrome [4].…”