The Relationship Between Left Ventricular Hypertrophy and Diabetes is Likely Bidirectional: A Temporality Analysis

Abstract

Objective: The temporal relationship between type 2 diabetes (T2DM) and left ventricular hypertrophy (LVH) is not well established. This study aims to examine the temporal sequence between glucose/T2DM, LVH and cardiac geometry patterns in middle-aged adults. Methods: The longitudinal cohort consisted of 1000 adults (682 whites and 318 blacks; 41.1% males, mean age=36.2 years at baseline) who had data on fasting glucose/T2DM, left ventricular mass index (LVMI) and relative wall thickness (RWT) collected twice at baseline and follow-up over 9.4 years on average. The cross-lagged path analysis model in 905 adults who did not take anti-diabetic medications and the longitudinal prediction model in 1000 adults were used to examine the temporal relationships of glucose/T2DM with LVMI, LVH, RWT and remodeling patterns. Results: After adjustment for age, race, sex, smoking, alcohol drinking, body mass index, heart rate, hypertension and follow-up years as well as baseline glucose, LVMI or RWT, the path coefficient from baseline LVMI to follow-up glucose was 0.088 (p=0.005); the path from baseline glucose to follow-up LVMI was -0.009 (p=0.758). The two paths between glucose and RWT were not significant. The path analysis parameters did not differ significantly between race, sex and follow-up duration subgroups. Incidence of T2DM was higher in the baseline LVH group than in the normal LVMI group (24.8% vs 8.8%, p=0.017 for difference). Incidence of LVH and concentric LVH was higher in the baseline T2DM group than in the non-diabetic group (50.0% vs 18.2% for LVH, p=0.005 for difference; 41.7% vs 12.6% for concentric LVH, p=0.004 for difference), with adjustment for covariates. Conclusions: This study suggests that the temporal relationship between T2DM and LVH is likely bidirectional. The path from LVMI/LVH to glucose/T2DM is stronger than the path from glucose/T2DM to LVMI/LVH. Funding Information: This study was supported by grants R03AG060619 from National Institute on Aging, R01HL121230 from the National Heart, Lung and Blood Institute, P20GM109036 from the National Institute of General Medical Sciences of the National Institutes of Health, 82073572 and 81973147 from National Natural Science Foundation of China and Z201100006820008 from the Beijing Nova Program. Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: All subjects gave informed consent for each survey. Study protocols were approved by the Institutional Review Board of the Tulane University Health Sciences Center.