Key result
Uncontrolled metabolic risk factors in T2D are linked to progressive structural and systolic dysfunction.
Why the study?
Does an increasing burden of uncontrolled metabolic risk factors worsen left ventricular structure and function in patients with type 2 diabetes mellitus?
Cross-Sectional (n=831)
Yes
Does an increasing burden of uncontrolled metabolic risk factors worsen left ventricular structure and function in patients with type 2 diabetes mellitus?
Absolute Event Rate: 7.7% vs 6.3%
p-value: p=<0.001
Even with well-controlled metabolic risk factors, patients with type 2 diabetes exhibit diastolic dysfunction, but structural and systolic impairments only emerge with an increasing burden of uncontrolled metabolic risk factors.
Suggests staged LV impairment in T2DM by risk factor burden; leaves open whether optimization prevents systolic decline.
Background Type 2 diabetes mellitus is closely associated with metabolic risk factors that all contribute to impairment of the left ventricle. The implications of having type 2 diabetes mellitus with well‐controlled metabolic risk factors compared to an increasing burden of uncontrolled metabolic risk factors on left ventricular structure and function are not known. Methods and Results We compared patients with type 2 diabetes mellitus (n=751) with different degrees of uncontrolled metabolic risk factors present with a control group of individuals without present uncontrolled metabolic risk factors as recommended by the World Health Organization (n=80). In patients with well‐controlled metabolic risk factors, only diastolic but neither structural nor systolic measures were impaired compared to the control group: the (early diastolic mitral inflow velocity)/(atrial diastolic mitral inflow velocity) ratio (median 0.94 [interquartile range 0.80, 1.08] versus 1.11 [0.85, 1.38], P <0.001), lateral early diastolic myocardial velocity at the level of the mitral annulus (mean 9.6 m/s [SD 2.5] versus 10.8 [3.5], P <0.001) and lateral (early diastolic mitral inflow velocity)/(early diastolic myocardial velocity at the level of the mitral annulus) (7.7 [6.5, 10.2] versus 6.3 [4.9, 7.8], P <0.001). With an increasing burden of uncontrolled metabolic risk factors, there were increased left ventricular mass index and wall thicknesses and impaired systolic function measured as global longitudinal strain: control group −15.9 (2.0); 0 uncontrolled risk factors −15.3 (2.4); 1 to 2 −14.6 (2.8); and ≥3 −14.0 (2.8), P <0.001. Within the diabetes mellitus group, there were uni‐ and multivariable associations of left ventricular measures and systolic blood pressure, body mass index, hemoglobin A 1c , and HDL ‐cholesterol. Conclusions In patients with type 2 diabetes mellitus, having well‐controlled metabolic risk factors was associated with only left ventricular diastolic impairment but not with either structural or even subtle measures of systolic function. Increasing burden of uncontrolled metabolic risk factors was associated with structural and functional impairments.
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Jørgensen et al. (2018) conducted a cross-sectional in Type 2 Diabetes Mellitus (n=831). Uncontrolled metabolic risk factors vs. Healthy controls and T2D patients with well-controlled metabolic risk factors was evaluated on Lateral E/e' ratio (early diastolic mitral inflow velocity / early diastolic myocardial velocity) (p=<0.001). In patients with type 2 diabetes mellitus, well-controlled metabolic risk factors were associated with isolated diastolic impairment, while an increasing burden of uncontrolled risk factors was associated with progressive structural and systolic impairments.
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