Abstract
Background: This study sought to investigate the prevalence and clinical outcome of left ventricular (LV) geometry in prediabetes and type 2 diabetes mellitus (T2DM) and the impact of glucose metabolism on the incidence of left ventricular hypertrophy (LVH). Methods: 15,010 subjects (35–74 years) of the population-based Gutenberg Health Study were categorized into euglycemia, prediabetes, and T2DM according to clinical and metabolic (HbA1c) information. Clinical outcome was assessed via structured follow-up. Results: The study comprised 12,121 individuals with euglycemia (81.6%), 1415 with prediabetes (9.5%), and 1316 with T2DM (8.9%). Prevalence of LVH increased from euglycemia (10.2%) over prediabetes (17.8%) to T2DM (23.8%). Prediabetes and T2DM were associated with increased LV mass index (prediabetes: β1.3 (95% CI 0.78–1.81), p < 0.0001; T2DM: β2.37 (95% CI 1.81; 2.92), p < 0.0001) independent of age, sex, and cardiovascular risk factors (CVRF). The frequency of LVH was related to the presence of T2DM (prevalence ratio (PR)T2DM 1.2 (95% CI 1.06–1.35), p = 0.0038). T2DM was related to mortality independent of age, sex, and CVRF regardless of LVH (hazard ratio (HR)T2DM-LVH 2.67 (95% CI 1.94–3.66), p < 0.0001; HRT2DM-noLVH 1.59 (95% CI 1.29–1.96), p < 0.0001), prediabetes was only associated with outcome in individuals with LVH independent of age and sex (HRprediabetes-LVH 1.51 (95% CI 1.01–2.25), p = 0.045). Neither T2DM nor prediabetes were predictors of incident LVH after adjustment for clinical covariates. Conclusions: Prediabetes and T2DM promote alterations of cardiac geometry. T2DM and particularly the coprevalence of T2DM with LVH substantially reduce life expectancy. These findings highlight the need for new therapeutic and screening approaches to prevent and detect cardiometabolic diseases at an early stage.
Highlights
Type 2 diabetes mellitus (T2DM) represents one of the key risk factors for the development of cardiovascular disease (CVD)
9426 individuals, euglycemic status was present, prediabetes was detected in 4128 subjects, and type 2 diabetes mellitus (T2DM) was observed in 1316 participants
The prevalence of abnormal left ventricular (LV) geometry in people with impaired glucose metabolism was previously described in the literature, beyond that, the present study reported prevalences of all subtypes of altered LV geometry in euglycemia, prediabetes, and T2DM
Summary
Type 2 diabetes mellitus (T2DM) represents one of the key risk factors for the development of cardiovascular disease (CVD). Individuals with T2DM are at a higher risk for developing coronary heart disease [1], heart failure [2], peripheral artery disease [3], and acute cardiovascular events such as myocardial infarction and stroke [4]. Besides the well-known cardiac affection due to the development of coronary artery disease and cardiac autonomic neuropathy, T2DM represents a risk factor for cardiac hypertrophy, which is highly prevalent even in asymptomatic diabetic patients and strongly associated with an increased risk for heart failure, stroke, and sudden death [5]. This study sought to investigate the prevalence and clinical outcome of left ventricular (LV) geometry in prediabetes and type 2 diabetes mellitus (T2DM) and the impact of glucose metabolism on the incidence of left ventricular hypertrophy (LVH).
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