Abstract
Introduction:
We assessed whether a longitudinal association between change in glucose homeostasis and change in cardiac structure and function was present.
Methods:
Data from ECHO-SOL baseline and visit 2 exams were used including 1643 Hispanic/Latino participants aged 45-74 years with serial echocardiograms obtained on average 4.3 (2.8-6.7) years apart. Glucose hoemostasis was evaluated through fasting plasma glucose levels (FGP), 2 hour oral glucose tolerance test (OGTT) and hemoglobin A1C (A1C) . Glucose homeostasis was categorized as: normal glucose tolerance (NGT) (FPG<100 mg/dL, 2hr OGTT <140 mg/dL, or A1C <5.7%), prediabetes (PDM) (FPG 100–125 mg/dL, or 2h OGTT 140–199 mg/dL, or A1C 5.7–6.4%); among those with self-report of diabetes or currently taking diabetes medicine: controlled diabetes (CDM) (A1C<7), and uncontrolled diabetes (UDM) (A1C>7). Linear regression models were used to examine associations between change in glucose homeostasis [worsening (NGT to PDM, NGT to DM, PDM to DM, CDM to UDM) vs unchanged] with changes in left ventricular mass (LVM), relative wall thickness (RWT), ejection fraction (EF), global longitudinal strain (GLS) and E’ velocity. All analyses were weighted to account for the complex survey design.
Results:
At baseline (mean age 56.4 years ±0.35; 45.4% male), glucose regulation was as follows: NGT (29.1%), PDM (51.8%), CDM (9.2%) and UDM (9.9%). At visit 2, glucose downregulation was as follows: NGT to PDM (55.9%), NGT to DM (13.4%), PDM to DM (27.4%), CDM to UCDM (33.5%). Among those with worsening glucose homeostasis the average age was 55.2 ±0.50 years, 45.7% were male, FPG was 99.4±0.90mg/dL . Change from NGT to PDM compared to remaining at NGT was associated with increase LVM (b=4.0 ±0.9, p<0.001), worsening in GLS (b=0.6 ±0.1, p<0.001) and decrease in E’ velocity (b=-1.1 ±0.1, p<0.001). Neither change from NGT to DM nor from PDM to DM was associated with significant changes in cardiac structure and function. Change from CDM to UDM was associated with increase in RWT (b=0.1 ±0.0, p<0.05), compared to those with unchanged CDM. Worsening glucose homeostasis from any group was not associated with changes in EF.
Conclusions:
Early stages of worsening glucose homeostasis were associated with cardiac structural and functional changes. Identification of those at risk of developing prediabetes may provide opportunities to prevent future cardiac dysfunction.
