Cardiovascular risk associated with diabetes may be partially attributed to left ventricular structural abnormalities. However, the relations between left ventricular structure and diabetes have not been extensively studied in African-Americans.
We studied 514 male and 965 female African-Americans 51 to 70 years old, in whom echocardiographic left ventricular mass measurements were collected for the ARIC Study. In these, we investigated the independent association of diabetes with left ventricular structural abnormalities.
Diabetes, hypertension and obesity prevalences were 22%, 57% and 45%, respectively. Unindexed left ventricular mass was higher with diabetes in both men (238.3 ├é┬▒ 79.4 g vs. 213.7 ├é┬▒ 58.6 g; p < 0.001) and women (206.4 ├é┬▒ 61.5 g vs. 176.9 ├é┬▒ 50.1 g; p < 0.001), respectively. Prevalence of height-indexed left ventricular hypertrophy was higher in women while increased relative wall thickness was similar in men and women. Those with diabetes had higher prevalences of height-indexed left ventricular hypertrophy (52% vs. 32%; p < 0.001), and of increased relative wall thickness (73% vs. 64%; p = 0.002). Gender-adjusted associations of diabetes with left ventricular hypertrophy (OR = 2.29 95%CI:1.79├óÔé¼ÔÇ£2.94) were attenuated after multiple adjustments in logistic regression (OR = 1.50 95%CI:1.12├óÔé¼ÔÇ£2.00). Diabetes was associated with higher left ventricle diameter (OR = 2.13 95%CI:1.28├óÔé¼ÔÇ£3.53) only in men and with higher wall thickness (OR = 1.89 95%CI:1.34├óÔé¼ÔÇ£2.66) only in women. Attenuations in diabetes associations were frequently seen after adjustment for obesity indices.
In African-Americans, diabetes is associated with left ventricular hypertrophy and, with different patterns of left ventricular structural abnormalities between genders. Attenuation seen in adjusted associations suggests that the higher frequency of structural abnormalities seen in diabetes may be due to factors other than hyperglycemia.
Left ventricular hypertrophy (LVH) is frequent in diabetic patients [1,2]. and has been identified as a powerful marker of impaired prognosis in cardiovascular disease , including in African-Americans .
Alterations in left ventricular (LV) structure have been linked to diabetes but also to a large number of related conditions such as aging, hypertension, obesity, central obesity, dyslipidemia, salt intake, and physical inactivity [5-7] Hence, the underlying processes common to the coexistent risk factors, as opposed to hyperinsulinemia or hyperglycemia, per se, may explain much of the association seen between diabetes and LV structural abnormalities.
- Galderisi M, Anderson KM, Wilson PWF, Levy D: Echocardiographic evidence for a existence of a distinct cardiomyopathy (The Framingham Heart Study). Am J Cardiol 1991, 68:85-89.
- Lee M, Gardin JM, Lynch JC, Smith V-E, Tracy RP, Savage PJ, Szklo M, Ward BJ: Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study. Am Heart J 1997, 133:36-43.
- Vakili BA, Okin PM, Devereux RB: Prognostic implications of left ventricular hypertrophy. Am Heart J 2001, 141:334-341.
- Liao Y, McGee DL, Cao G, Cooper RS: Black-white differences in disability and morbidity in the last years of life. Am J Epidemiol 1999, 149:1097-1103.
- Levy D: Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors. The Framingham Heart Study. Ann Intern Med 1988, 108:7-13.
- Gardin JM, Arnold A, Gottdiener JS, Wong ND, Fried LP, Klopfenstein HS, O'Leary DH, Tracy R, Kronmal R: Left ventricular mass in the elderly. The Cardiovascular Health Study. Hypertension 1997, 29:1095-1103.
- Devereux RB, Roman MJ, De Simone G, O'Grady MJ, Paranicas M, Yeh JL, Fabsitz RR, Howard BV: Relations of left ventricular mass to demographic and hemodynamic variables in American Indians: the Strong Heart Study. Circulation 1997, 96:1416-1423.
- Liebson PR, Grandits G, Prineas R, Dianzumba S, Flack JM, Cutler JA, Grimm R, Stamler J: Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1993, 87:476-486.
- Zabalgoitia M, Ur Rahman SN, Haley WE, Oneschuk L, Yunis C, Lucas C, Yarows S, Krause L, Amerena J: Impact of ethnicity on left ventricular mass and relative wall thickness in essential hypertension. Am J Cardiol 1998, 81:412-417.
- Fox E, Taylor H, Andrew M, Han H, Mohamed E, Garrison R, Skelton T: Body mass index and blood pressure influences on left ventricular mass and geometry in African Americans: The Atherosclerotic Risk In Communities (ARIC) Study. Hypertension 2004, 44:55-60.
- Palmieri V, Bella JN, Arnett DK, Liu JE, Oberman A, Schuck MY, Kitzman DW, Hopkins PN, Morgan D, Rao DC, et al.: Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN) study. Circulation 2001, 103:102-107.
- Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, Hoogeveen R, Folsom AR, Heiss G: Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes 2003, 52:1799-1805.
- Rohde LE, Zhi G, Aranki SF, Beckel NE, Lee RT, Reimold SC: Gender-associated differences in left ventricular geometry in patients with aortic valve disease and effect of distinct overload subsets. Am J Cardiol 1997, 80:475-480.
- The ARIC Investigators: The Atherosclerosis Risk in Communities (ARIC) Study: Design and objectives. Am J Epidemiol 1989, 129:687-702.
- http://www.cscc.unc.edu/aric/visit/index.phtml?visit=3] webcite Collaborative Studies Coordinating Center, University of North Carolina: ARIC study documents: manuals, visit 3.
- Dubois D, Dubois EF: A formula to estimate the aproximate surface area if height and weight be known. Arch Intern Med 1916, 17:863-871.
- Sahn DJ, DeMaria A, Kisslo J, Weyman A: The committee on M-mode Standardization of the American Society of Echocardiography: recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic methods. Circulation 1978, 58:1072-1083.
- Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N: Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986, 57:450-458.
- De Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH: Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 1995, 25:1056-1062.
- Skelton TN, Andrew ME, Arnett DK, Burchfiel CM, Garrison RJ, Samdarshi TE, Taylor HA, Hutchinson RG: Echocardiographic left ventricular mass in African-Americans: the Jackson cohort of the Atherosclerosis Risk in Communities Study. Echocardiography 2003, 20:111-120.
- Ganau A, Devereux RB, Roman MJ, De Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH: Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992, 19:1550-1558.
- Kleinbaun DG, Kupper LL, Muller KE: Applied regression analysis and mulitvariable methods. Boston: PWS-Kent Publishing Company; 1988.
- Ilercil A, Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Welty TK, Robbins DC, Fabsitz RR, Howard BV, Lee ET: Relationship of impaired glucose tolerance to left ventricular structure and function: The Strong Heart Study. Am Heart J 2001, 141:992-998.
- Weinberg EO, Thienelt CD, Katz SE, Bartunek J, Tajima M, Rohrbach S, Douglas PS, Lorell BH: Gender differences in molecular remodeling in pressure overload hypertrophy. J Am Coll Cardiol 1999, 34:264-273.
- Schillaci G, Pirro M, Pucci G, Mannarino MR, Gemelli F, Siepi D, Vaudo G, Mannarino E: Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension 2006, 47(5):881-6.
- Ilercil A, Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK, Fabsitz RR, Howard BV: Associations of insulin levels with left ventricular structure and function in American Indians: the strong heart study. Diabetes 2002, 51:1543-1547.
- Rutter MK, Parise H, Benjamin EJ, Levy D, Larson MG, Meigs JB, Nesto RW, Wilson PW, Vasan RS: Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study. Circulation 2003, 107:448-454.
- Galvan AQ, Galetta F, Natali A, Muscelli E, Sironi AM, Cini G, Camastra S, Ferrannini E: Insulin resistance and hyperinsulinemia: No independent relation to left ventricular mass in humans. Circulation 2000, 102:2233-2238.
- Lee KW, Lip GY: Insulin resistance and vascular remodelling, in relation to left ventricular mass, geometry and function: an answer to LIFE? J Hum Hypertens 2003, 17:299-304.
- Devereux RB, De Simone G, Palmieri V, Oberman A, Hopkins P, Kitzman DW, Rao DC, Arnett DK: Relation of insulin to left ventricular geometry and function in African American and white hypertensive adults: the HyperGEN study. Am J Hypertens 2002, 15:1029-1035.
- Alpert MA, Terry BE, Kelly DL: Effect of weight loss on cardiac chamber size, wall thickness and left ventricular function in morbid obesity. Am J Cardiol 1985, 55:783-786.
- Schmidt MI, Duncan BB: Diabesity: an inflammatory metabolic condition. Clin Chem Lab Med 2003, 41:1120-1130.
- Lips DJ, deWindt LJ, van Kraaij DJ, Doevendans PA: Molecular determinants of myocardial hypertrophy and failure: alternative pathways for beneficial and maladaptive hypertrophy. Eur Heart J 2003, 24:883-896.
- Vasan RS, Sullivan LM, Roubenoff R, Dinarello CA, Harris T, Benjamin EJ, Sawyer DB, Levy D, Wilson PW, D'Agostino RB: Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study. Circulation 2003, 107:1486-1491.
- Brownlee M: Biochemistry and molecular cell biology of diabetic complications. Nature 2001, 414:813-820.
- Avendano GF, Agarwal RK, Bashey RI, Lyons MM, Soni BJ, Jyothirmayi GN, Regan TJ: Effects of glucose intolerance on myocardial function and collagen-linked glycation. Diabetes 1999, 48:1443-1447.
- Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C: Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004, 109:433-438.
- Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP: Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987, 59:956-960.