Diabetes, gender, and left ventricular structure in African-Americans: the atherosclerosis risk in communities study

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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 [3], including in African-Americans [4].

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.


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