Subclinical Cardiac Dysfunction in Women With Prior Gestational Diabetes: The Hispanic Community Study/Study of Latinos

BACKGROUND: Gestational diabetes (GD) is associated with heart failure risk. However, the association of GD and postpartum early stages of myocardial dysfunction (a robust predictor of heart failure) as assessed by imaging has seldom been examined, especially among Hispanic women, who represent the fastest-growing ethnic minority population and have the highest prevalence of GD in US women. METHODS: We examined Hispanic women recruited to the Hispanic Community Study/Study of Latinos cohort, who reported at least 1 prior pregnancy and GD history at either visit 1 (2008-2011) or visit 2 (2014-2017) and echocardiographic assessments at visit 2. We used multivariable linear and logistic regression models to evaluate the associations between GD history and echocardiographic parameters. RESULTS: Among 2894 participants (mean age 53±9 years), 9.3% (n=270) had a GD history. After adjusting for cardiovascular disease risk factors, including current diabetes status, Hispanic women with GD history had higher mean adjusted left ventricular relative wall thickness (β=0.01 [95% CI, 0.00-0.02]), lateral peak early mitral inflow velocity to early diastolic velocity of the mitral annulus ratio (β=0.49 [95% CI, 0.09-0.89]), abnormal left ventricular diastolic function (adjusted odds ratio, 1.41 [95% CI, 1.04-1.91]), and lower mean adjusted left ventricular end-diastolic diameter (β=-0.07 [95% CI, -0.12 to -0.02]) compared with those without prior GD history. Similar associations were observed in results stratified by the most recent glycemic status. CONCLUSIONS: History of GD was associated with a higher frequency and severity of myocardial diastolic abnormalities. Echocardiographic-based screening for myocardial dysfunction in women with GD history has the potential to help avert overt cardiovascular disease in this high-risk population.