The Prevalence and Outcome of Diabetic Cardiomyopathy: A Population Based Study in Olmsted County, MN

Abstract

Background: Diabetic cardiomyopathy defined as either systolic or diastolic dysfunction in otherwise healthy diabetic persons is not clearly understood. The prevalence and outcome of this disease in a community-based population has never been defined. Methods: Cross-sectional survey of 2,042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. All patients underwent Doppler echocardiographic assessment of systolic and diastolic function. Diabetic cardiomyopathy was defined as a person with diabetes mellitus and any systolic dysfunction (defined as EF <50%) or diastolic dysfunction (defined as an E/A ratio ≤0.75 or ≥2.0 or an E/e' ratio is ≥10) without a history of coronary disease, hypertension, significant valvular disease or congenital heart disease. The main outcomes measure was all-cause mortality. Results: The diagnosis of diabetic cardiomyopathy was made in 23 persons, corresponding to a population prevalence rate of 1.1% (95% confidence interval [CI] 0.7% to 1.6%) in the community. Mortality of patients with Diabetic Cardiomyopathy was nearly 20% during the 9.2 + /− 1.5 year follow-up. Mortality among patients with Diabetic Cardiomyopathy was similar to diabetic persons with left ventricular dysfunction who had hypertension or coronary disease (RR = 0.424, 95% CI = 0.146 to 1.230; p = 0.114) after adjustment for age and sex. Among all diabetic patients 18 (11%) had systolic dysfunction and 101 (60%) had diastolic dysfunction. Among non-diabetic patients 71 (4%) had systolic dysfunction and 806 (43%) had diastolic dysfunction. Diabetes mellitus was associated with a 1.5 fold increase in any left ventricular dysfunction (OR = 1.50 (95% CI = 1.05 to 2.14; p = 0.026) and a 1.4 fold increase in diastolic dysfunction (OR = 1.40 (95% CI = 0.98 to 1.98; p = 0.062) after adjustment for age, gender, coronary disease and hypertension. Conclusions: Diabetic Cardiomyopathy is common in the community. Mortality among diabetic patients with left ventricular dysfunction is high regardless of the presence of hypertension or coronary disease. Furthermore, diabetes mellitus is independently associated with left ventricular dysfunction after adjustment for age, gender, coronary disease and hypertension. Background: Diabetic cardiomyopathy defined as either systolic or diastolic dysfunction in otherwise healthy diabetic persons is not clearly understood. The prevalence and outcome of this disease in a community-based population has never been defined. Methods: Cross-sectional survey of 2,042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. All patients underwent Doppler echocardiographic assessment of systolic and diastolic function. Diabetic cardiomyopathy was defined as a person with diabetes mellitus and any systolic dysfunction (defined as EF <50%) or diastolic dysfunction (defined as an E/A ratio ≤0.75 or ≥2.0 or an E/e' ratio is ≥10) without a history of coronary disease, hypertension, significant valvular disease or congenital heart disease. The main outcomes measure was all-cause mortality. Results: The diagnosis of diabetic cardiomyopathy was made in 23 persons, corresponding to a population prevalence rate of 1.1% (95% confidence interval [CI] 0.7% to 1.6%) in the community. Mortality of patients with Diabetic Cardiomyopathy was nearly 20% during the 9.2 + /− 1.5 year follow-up. Mortality among patients with Diabetic Cardiomyopathy was similar to diabetic persons with left ventricular dysfunction who had hypertension or coronary disease (RR = 0.424, 95% CI = 0.146 to 1.230; p = 0.114) after adjustment for age and sex. Among all diabetic patients 18 (11%) had systolic dysfunction and 101 (60%) had diastolic dysfunction. Among non-diabetic patients 71 (4%) had systolic dysfunction and 806 (43%) had diastolic dysfunction. Diabetes mellitus was associated with a 1.5 fold increase in any left ventricular dysfunction (OR = 1.50 (95% CI = 1.05 to 2.14; p = 0.026) and a 1.4 fold increase in diastolic dysfunction (OR = 1.40 (95% CI = 0.98 to 1.98; p = 0.062) after adjustment for age, gender, coronary disease and hypertension. Conclusions: Diabetic Cardiomyopathy is common in the community. Mortality among diabetic patients with left ventricular dysfunction is high regardless of the presence of hypertension or coronary disease. Furthermore, diabetes mellitus is independently associated with left ventricular dysfunction after adjustment for age, gender, coronary disease and hypertension.