The prevalence of diabetic cardiomyopathy: a population-based study in Olmsted County, Minnesota

Abstract

Background: Diabetic cardiomyopathy defined as either systolic or diastolic dysfunction in otherwise healthy diabetic persons is not clearly understood. The prevalence and outcomes of this disease in a community-based population have not been defined.

Methods and results: Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older between June 1997 and September 2000. All patients underwent Doppler echocardiographic assessment of systolic and diastolic function. Diabetic cardiomyopathy was defined in a person with diabetes and any systolic or at least moderate diastolic dysfunction without a history of coronary disease, hypertension, significant valvular disease, or congenital heart disease. The diagnosis of diabetic cardiomyopathy was made in 23 people, corresponding to a community population prevalence rate of 1.1%. Among diabetic patients, 16.9% met criteria for diabetic cardiomyopathy and 54.4% had diastolic dysfunction. Diabetes was associated with a 1.9-fold increase in risk of any left ventricular dysfunction, a 1.7-fold increase in risk of diastolic dysfunction, and a 2.2-fold increase in risk of systolic dysfunction. Among patients with diabetic cardiomyopathy, the cumulative probability of death was 18%, development of heart failure was 22%, and development of death or heart failure was 31% at 9 years.

Conclusion: Diabetic cardiomyopathy is relatively common in the community with a prevalence of 1.1%. The morbidity and mortality of patients with diabetic cardiomyopathy is high.

Keywords: Diabetes mellitus; Olmsted County; diabetic cardiomyopathy; heart failure; left ventricular dysfunction; prevalence.

Figure 1. Comparison of B-type Natriuretic Peptide Levels

The top of box is the 25% percentile, the middle bar in the box is the median and the bottom of box is the 75% percentile. The end lines outside the box are the statistical range. The open circles are the statistical outliers. The asterisk represents a statistically significant difference (p<0.05) when comparing D1CM to DOCM

Figure 2. Kaplan-Meier Analysis of Survival

The unadjusted P value is for comparison to the healthy controls.

Figure 3. Kaplan-Meier Analysis of Development of Heart Failure

The unadjusted P value is for trend.

Figure 4. Kaplan-Meier Analysis of Survival and Development of Heart Failure

The unadjusted P value is for trend.