Abstract
BackgroundSubtle impairments in left ventricular (LV) function and geometry are common findings in individuals with diabetes. However, whether these impairments precede the development of diabetes mellitus (DM) is not entirely clear.MethodsEchocardiograms from 1710 individuals from the general population free of prevalent diabetes mellitus were analyzed. Left ventricular (LV) concentric geometry was defined as either LV concentric remodeling or LV concentric hypertrophy as directed in contemporary guidelines. The severity of LV concentricity was assessed by relative wall thickness (RWT) calculated as posterior wall thickness (PWT) indexed to left ventricular internal diameter at end diastole (LVIDd) (RWT = 2 * PWT/LVIDd). End-point was incident DM.ResultsMedian follow-up time was 12.6 years (IQR: 12.0–12.8 years). Follow-up was a 100%. A total of 55 participants (3.3%) developed DM during follow-up. At baseline, the prevalence of a concentric LV geometric pattern was significantly higher (41.8% vs 20.3%, p < 0.001) in individuals who developed DM during follow-up. In a final multivariable model adjusting for established DM risk factors including HbA1c, BMI and plasma glucose, LV concentric geometry and RWT remained significantly associated with incident DM (LV concentric geometry: HR 1.99, 95% CI 1.11–3.57, p = 0.021) (RWT: HR 1.41, 95% CI 1.06–1.86, p = 0.017, per 0.1 increase). This association remained despite adjustment for established risk factors for DM.ConclusionAltered LV geometry may precede the development of DM. LV concentric geometry determined by echocardiography and the severity of LV concentricity evaluated as RWT are associated with incident DM in the general population.
Highlights
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (CVD) [1], and the increasing prevalence of diabetes mellitus (DM) in the years to come represents one of the greatest threats to public health
Glucose homeostasis is closely tied to cardiovascular pathology, and even in subjects not diagnosed with fulminant DM, dysfunctional glucose homeostasis significantly increases the risk of CVD [3]
These findings concur with our results, since left ventricular (LV) concentric geometry and relative wall thickness (RWT) were the only echocardiographic predictors of incident DM in the present study, and since the risk of DM increased continuously with increasing degree of LV concentricity as evaluated by RWT, suggesting that LV concentricity is correlated to abnormal glucose metabolism
Summary
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (CVD) [1], and the increasing prevalence of DM in the years to come represents one of the greatest threats to public health. Since many risk factors for diabetes are modifiable, identification of individuals at high risk of developing diabetes is needed to initiate preventive measures as early as possible. Glucose homeostasis is closely tied to cardiovascular pathology, and even in subjects not diagnosed with fulminant DM, dysfunctional glucose homeostasis significantly increases the risk of CVD [3]. Subtle impairments in left ventricular (LV) function and geometry are common findings in individu‐ als with diabetes. Whether these impairments precede the development of diabetes mellitus (DM) is not entirely clear
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