Key result
Co-existing diabetes linked to ~12 percentage points higher myocardial fibrosis prevalence in hypertensive patients.
Why the study?
Patients with hypertension and diabetes have worse prognosis than those with hypertension alone, but morphological differences and proteomic signatures associated with myocardial fibrosis between these groups remained to be characterized.
Does co-existing diabetes accelerate myocardial fibrosis and adverse cardiac remodeling in asymptomatic patients with hypertension?
Observational (n=605)
No
Does co-existing diabetes accelerate myocardial fibrosis and adverse cardiac remodeling in asymptomatic patients with hypertension?
In asymptomatic hypertensive patients, concomitant diabetes is associated with increased morphological myocardial fibrosis and adverse cardiac remodeling, highlighting the need for early risk stratification.
Answers are grounded in this paper and cite their sources.
May inform fibrosis risk stratification in comorbid hypertension-diabetes; extends cross-sectional data but leaves causal impact and intervention effects open.
BACKGROUND: Compared with patients with hypertension only, those with hypertension and diabetes (HTN/DM) have worse prognosis. We aimed to characterize morphological differences between hypertension and HTN/DM using cardiovascular magnetic resonance; and compare differentially expressed proteins associated with myocardial fibrosis using high throughput multiplex assays. METHODS: Asymptomatic patients underwent cardiovascular magnetic resonance: 438 patients with hypertension (60±8 years; 59% males) and 167 age- and sex-matched patients with HTN/DM (60±10 years; 64% males). Replacement myocardial fibrosis was defined as nonischemic late gadolinium enhancement on cardiovascular magnetic resonance. Extracellular volume fraction was used as a marker of diffuse myocardial fibrosis. A total of 184 serum proteins (Olink Target Cardiovascular Disease II and III panels) were measured to identify unique signatures associated with myocardial fibrosis in all patients. RESULTS: Despite similar left ventricular mass ( P =0.344) and systolic blood pressure ( P =0.086), patients with HTN/DM had increased concentricity and worse multidirectional strain ( P <0.001 for comparison of all strain measures) compared to hypertension only. Replacement myocardial fibrosis was present in 28% of patients with HTN/DM compared to 16% of those with hypertension ( P <0.001). NT-proBNP (N-terminal pro-B-type natriuretic peptide) was the only protein differentially upregulated in hypertension patients with replacement myocardial fibrosis and independently associated with extracellular volume. In patients with HTN/DM, GDF-15 (growth differentiation factor 15) was independently associated with replacement myocardial fibrosis and extracellular volume. Ingenuity Pathway Analysis demonstrated a strong association between increased inflammatory response/immune cell trafficking and myocardial fibrosis in patients with HTN/DM. CONCLUSIONS: Adverse cardiac remodeling was observed in patients with HTN/DM. The novel proteomic signatures and associated biological activities of increased immune and inflammatory response may partly explain these observations.
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Pua et al. (2023) conducted an observational in Hypertension with or without diabetes (n=605). Co-existing diabetes mellitus (HTN/DM) vs. Hypertension only was evaluated on Replacement myocardial fibrosis (nonischemic late gadolinium enhancement) (p=<0.001). In asymptomatic patients with hypertension, co-existing diabetes was associated with a higher prevalence of replacement myocardial fibrosis compared to hypertension alone (28% vs 16%, p<0.001).
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