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Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos).
Circ Cardiovasc Imaging. 2016 Oct; 9(10)CC

Abstract

BACKGROUND

We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics.

METHODS AND RESULTS

ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all P<0.05), reduced ejection fraction (P<0.01), reduced stroke and end-diastolic volumes (both P<0.001), decreased peak E' velocity (lateral and septal P<0.001), and increased E/E' ratio (lateral and septal P<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96-1.9) and 1.90 (1.3-2.8), respectively(P=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E' (P<0.001), and greater relative wall thickness and septal thickness (both P<0.05); lower stroke volume (P<0.0001); and lower peak lateral and septal E' velocities (both P<0.01).

CONCLUSIONS

Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even before the development of diabetes mellitus.

Authors+Show Affiliations

From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). rtd2106@cumc.columbia.edu.From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27729362

Citation

Demmer, Ryan T., et al. "Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos)." Circulation. Cardiovascular Imaging, vol. 9, no. 10, 2016.
Demmer RT, Allison MA, Cai J, et al. Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circ Cardiovasc Imaging. 2016;9(10).
Demmer, R. T., Allison, M. A., Cai, J., Kaplan, R. C., Desai, A. A., Hurwitz, B. E., Newman, J. C., Shah, S. J., Swett, K., Talavera, G. A., Thai, A., Youngblood, M. E., & Rodriguez, C. J. (2016). Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circulation. Cardiovascular Imaging, 9(10).
Demmer RT, et al. Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). Circ Cardiovasc Imaging. 2016;9(10) PubMed PMID: 27729362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos). AU - Demmer,Ryan T, AU - Allison,Matthew A, AU - Cai,Jianwen, AU - Kaplan,Robert C, AU - Desai,Ankit A, AU - Hurwitz,Barry E, AU - Newman,Jill C, AU - Shah,Sanjiv J, AU - Swett,Katrina, AU - Talavera,Gregory A, AU - Thai,Ashley, AU - Youngblood,Marston E, AU - Rodriguez,Carlos J, PY - 2016/02/06/received PY - 2016/08/26/accepted PY - 2016/10/13/entrez PY - 2016/10/13/pubmed PY - 2017/5/10/medline KW - diabetes mellitus KW - diabetic cardiomyopathy KW - echocardiography KW - insulin resistance KW - prediabetic state JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 9 IS - 10 N2 - BACKGROUND: We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics. METHODS AND RESULTS: ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all P<0.05), reduced ejection fraction (P<0.01), reduced stroke and end-diastolic volumes (both P<0.001), decreased peak E' velocity (lateral and septal P<0.001), and increased E/E' ratio (lateral and septal P<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96-1.9) and 1.90 (1.3-2.8), respectively(P=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E' (P<0.001), and greater relative wall thickness and septal thickness (both P<0.05); lower stroke volume (P<0.0001); and lower peak lateral and septal E' velocities (both P<0.01). CONCLUSIONS: Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even before the development of diabetes mellitus. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/27729362/Association_of_Impaired_Glucose_Regulation_and_Insulin_Resistance_With_Cardiac_Structure_and_Function:_Results_From_ECHO_SOL__Echocardiographic_Study_of_Latinos__ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005032?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -