Abstract
BackgroundGlycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction. Obesity is a risk factor of type 2 diabetes. To understand the relationships between HbA1c, body mass index (BMI) and LV diastolic dysfunction, we performed this interaction analysis in patients with type 2 diabetes.MethodsTotal 925 type 2 diabetes patients were selected from the patients who were diagnosed and treated at the First Affiliated Hospital of Shenzhen University. Patients’ BMI levels were defined as normal (BMI < 24 kg/m2) and overweight /obese (BMI ≥ 24 kg/m2). Patients’ HbA1c levels were grouped as HbA1c ≥ 9%、7% ≤ HbA1c < 9% and HbA1c < 7%. Logistic regression, stratified, interaction analysis, multivariate Cox regression and curve fitting analysis were performed to investigate the correlations and interactions between HbA1c and BMI with LV diastolic dysfunction.ResultsThe BMI levels were significantly associated with LV diastolic dysfunction in the patients with type 2 diabetes [adjusted model: 1.12 (1.05, 1.20), P = 0.001]. While HbA1c levels had association with LV diastolic dysfunction only in normal BMI group patients [adjusted model: 1.14 (1.01, 1.30), P = 0.0394] and curve correlation was observed. There was a significant interaction between BMI and HbA1c to affect LV diastolic dysfunction (P = 0.0335). Cox regression model analysis showed that the risk of LV diastolic dysfunction was a U type correlation with HbA1c levels in the normal weight group and the turning point was HbA1c at 10%. HbA1c level was not found to have a significant association with LV diastolic dysfunction in overweight/obese group.ConclusionsIn patients with type 2 diabetes, correlation between LV diastolic dysfunction and HbA1c was interactively affected by BMI. Glycemic control is beneficial to the heart function in normal body weight patients. For overweight/obese patients, the risk of LV diastolic dysfunction was not determined by the HbA1c level, indicating it may be affected by other confounding factors.
Highlights
Glycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction
There were no significant differences in age, total cholesterol, high-density lipoprotein, low-density lipoprotein, Estimated glomerular filtration rate (eGFR), Hemoglobin A1c or glycosylated hemoglobin (HbA1c) levels between two groups (P > 0.05)
We found that HbA1c was significantly associated with LV diastolic dysfunction in the normal weight group (OR = 1.14 (1.01, 1.30), P = 0.0394), whereas not in overweight/obese group (OR = 0.92 (0.82, 1.03), P = 0.1315), suggesting that the association between HbA1c and left ventricular diastolic dysfunction is affected by body mass index (BMI) levels
Summary
Glycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction. To understand the relationships between HbA1c, body mass index (BMI) and LV diastolic dysfunction, we performed this interaction analysis in patients with type 2 diabetes. Cardiovascular complications are the leading causes of death in patients with diabetes [2]. Hyperglycaemia in patients with diabetes can have much detrimental impacts on the myocardium form lipotoxicity, mitochondrial dysfunction, abnormal substrate metabolism and impaired calcium handling [5,6,7]. Glycosylated hemoglobin plays an important role in the assessment of the occurrence, development and prognosis of diabetic cardiovascular complications. The high incidence of diastolic dysfunction was found in asymptomatic diabetes correlating with HbA1c levels in Indian patients [10]
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