Diabetes mellitus was associated with increased odds of diastolic dysfunction compared to diabetes-free individuals (OR 1.90; 95% CI 1.3-2.8; P=0.006) among US Hispanics.
Cross-Sectional (n=1,818)
Yes
Are impaired glucose regulation and insulin resistance associated with adverse cardiac structure and function in Hispanic/Latino adults?
Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and worsened diastolic function in Hispanic/Latino adults, even prior to the onset of overt diabetes.
Effect estimate: OR 1.90 (95% CI 1.3-2.8)
p-value: p=0.006
BACKGROUND: We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics. METHODS AND RESULTS: ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all P<0.05), reduced ejection fraction (P<0.01), reduced stroke and end-diastolic volumes (both P<0.001), decreased peak E' velocity (lateral and septal P<0.001), and increased E/E' ratio (lateral and septal P<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96-1.9) and 1.90 (1.3-2.8), respectively(P=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E' (P<0.001), and greater relative wall thickness and 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 before the development of diabetes mellitus.
Demmer et al. (Sat,) conducted a cross-sectional in Impaired glucose regulation and insulin resistance (n=1,818). Glucose intolerance (prediabetes and diabetes mellitus) vs. Diabetes mellitus free was evaluated on Diastolic dysfunction (OR 1.90, 95% CI 1.3-2.8, p=0.006). Diabetes mellitus was associated with increased odds of diastolic dysfunction compared to diabetes-free individuals (OR 1.90; 95% CI 1.3-2.8; P=0.006) among US Hispanics.