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Multicenter Study
. 2016 Oct;9(10):e005032.
doi: 10.1161/CIRCIMAGING.116.005032.

Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos)

Ryan T Demmer  1 , Matthew A Allison  2 , Jianwen Cai  2 , Robert C Kaplan  2 , Ankit A Desai  2 , Barry E Hurwitz  2 , Jill C Newman  2 , Sanjiv J Shah  2 , Katrina Swett  2 , Gregory A Talavera  2 , Ashley Thai  2 , Marston E Youngblood  2 , Carlos J Rodriguez  2
Affiliations
Multicenter Study

Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos)

Ryan T Demmer et al. Circ Cardiovasc Imaging. 2016 Oct.

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.

Keywords: diabetes mellitus; diabetic cardiomyopathy; echocardiography; insulin resistance; prediabetic state.

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Figures

FIGURE 1
FIGURE 1
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of cardiac structure. Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 2
FIGURE 2
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of systolic function including: ejection fraction and stroke volume (a), end diastolic volume (b), end systolic volume (c) and lateral peak S velocity (d). Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 2
FIGURE 2
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of systolic function including: ejection fraction and stroke volume (a), end diastolic volume (b), end systolic volume (c) and lateral peak S velocity (d). Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 2
FIGURE 2
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of systolic function including: ejection fraction and stroke volume (a), end diastolic volume (b), end systolic volume (c) and lateral peak S velocity (d). Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 2
FIGURE 2
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of systolic function including: ejection fraction and stroke volume (a), end diastolic volume (b), end systolic volume (c) and lateral peak S velocity (d). Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 3
FIGURE 3
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of diastolic function including: E/e' lateral and E/e' septal ratios (a), lateral peak E' and medial peak E' velocities (b), prevalent diastolic dysfunction (c), and (d) predicted end diastolic volume at an ED pressure of 20 mmHg. Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 3
FIGURE 3
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of diastolic function including: E/e' lateral and E/e' septal ratios (a), lateral peak E' and medial peak E' velocities (b), prevalent diastolic dysfunction (c), and (d) predicted end diastolic volume at an ED pressure of 20 mmHg. Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 3
FIGURE 3
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of diastolic function including: E/e' lateral and E/e' septal ratios (a), lateral peak E' and medial peak E' velocities (b), prevalent diastolic dysfunction (c), and (d) predicted end diastolic volume at an ED pressure of 20 mmHg. Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
FIGURE 3
FIGURE 3
Relationship between quintiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and measures of diastolic function including: E/e' lateral and E/e' septal ratios (a), lateral peak E' and medial peak E' velocities (b), prevalent diastolic dysfunction (c), and (d) predicted end diastolic volume at an ED pressure of 20 mmHg. Adjusted for age, sex, site, smoking status, alcohol use, physical activity, BMI, hypertension and chronic kidney disease. The scaling is based on clinically meaningful ranges. Zero was not included in the scale, as a value of zero is not biologically plausible.
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