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Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study.
JACC Cardiovasc Imaging. 2017 02; 10(2):105-114.JC

Abstract

OBJECTIVES

This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood.

BACKGROUND

Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life.

METHODS

In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction.

RESULTS

The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level.

CONCLUSIONS

Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.

Authors+Show Affiliations

Johns Hopkins University, Baltimore, Maryland; Mitsui Memorial Hospital, Tokyo, Japan.A.I. DuPont Hospital for Children, Wilmington, Delaware.National Heart, Lung, and Blood Institute, Bethesda, Maryland.Northwestern University, Chicago, Illinois.Johns Hopkins University, Baltimore, Maryland.Johns Hopkins University, Baltimore, Maryland.Mitsui Memorial Hospital, Tokyo, Japan.University of Alabama, Birmingham, Alabama.National Heart, Lung, and Blood Institute, Bethesda, Maryland.University of Minnesota School of Public Health, Minneapolis, Minnesota.Northwestern University, Chicago, Illinois.Johns Hopkins University, Baltimore, Maryland. Electronic address: jlima@jhmi.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Intramural
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27544896

Citation

Kishi, Satoru, et al. "Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: the CARDIA Study." JACC. Cardiovascular Imaging, vol. 10, no. 2, 2017, pp. 105-114.
Kishi S, Gidding SS, Reis JP, et al. Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study. JACC Cardiovasc Imaging. 2017;10(2):105-114.
Kishi, S., Gidding, S. S., Reis, J. P., Colangelo, L. A., Venkatesh, B. A., Armstrong, A. C., Isogawa, A., Lewis, C. E., Wu, C., Jacobs, D. R., Liu, K., & Lima, J. A. (2017). Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study. JACC. Cardiovascular Imaging, 10(2), 105-114. https://doi.org/10.1016/j.jcmg.2016.02.033
Kishi S, et al. Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: the CARDIA Study. JACC Cardiovasc Imaging. 2017;10(2):105-114. PubMed PMID: 27544896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study. AU - Kishi,Satoru, AU - Gidding,Samuel S, AU - Reis,Jared P, AU - Colangelo,Laura A, AU - Venkatesh,Bharath A, AU - Armstrong,Anderson C, AU - Isogawa,Akihiro, AU - Lewis,Cora E, AU - Wu,Colin, AU - Jacobs,David R,Jr AU - Liu,Kiang, AU - Lima,João A C, Y1 - 2016/08/17/ PY - 2015/12/22/received PY - 2016/02/17/revised PY - 2016/02/25/accepted PY - 2016/8/22/pubmed PY - 2017/10/27/medline PY - 2016/8/22/entrez KW - diabetes mellitus KW - echocardiography KW - insulin resistance KW - left ventricular function KW - obesity KW - speckle-tracking echocardiography SP - 105 EP - 114 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 10 IS - 2 N2 - OBJECTIVES: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood. BACKGROUND: Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life. METHODS: In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction. RESULTS: The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1c were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level. CONCLUSIONS: Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/27544896/Association_of_Insulin_Resistance_and_Glycemic_Metabolic_Abnormalities_With_LV_Structure_and_Function_in_Middle_Age:_The_CARDIA_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(16)30459-4 DB - PRIME DP - Unbound Medicine ER -