Published online before print January 13, 2003, doi: 10.1161/01.CIR.0000045671.62860.98
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;107:448.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function
Sex-Related Differences in the Framingham Heart Study
From the Framingham Heart Study (H.P., M.G.L., E.J.B., D.L., P.W.F.W., R.S.V.); Lahey Clinic (M.K.R., R.W.N.), Burlington, Mass; the Cardiology Section (E.J.B., R.S.V.) and Department of Preventative Medicine and Epidemiology (M.G.L., D.L., E.J.B., P.W.F.W., R.S.V.), Boston University School of Medicine, Boston, Mass; the Divisions of Cardiology and Clinical Epidemiology (D.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Department of Medicine (J.B.M.), Massachusetts General Hospital, Boston; and the National Heart, Lung, and Blood Institute (D.L.), Bethesda, Md.
Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA 01702-5827. E-mail vasan{at}fram.nhlbi.nih.gov
Background— Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias.
Methods and Results— We examined the relations between echocardiographic LV measurements and glucose tolerance status in 2623 Framingham Study subjects (1514 women, mean age 53 years) free of myocardial infarction and heart failure. We also evaluated the relations of insulin resistance (homeostasis model, HOMA-IR) and LV and left atrial (LA) measures within the normal and abnormal glucose tolerance categories (the latter included impaired glucose tolerance, impaired fasting glucose, and newly diagnosed diabetes). LV mass (adjusted for age, height, heart rate, and systolic blood pressure) increased across categories of worsening glucose tolerance; the trend was more striking in women (P<0.001) compared with men (P=0.054). In subjects with normal (n=2022) and abnormal glucose tolerance (n=327), covariate-adjusted LV mass and LV wall thickness increased across HOMA-IR quartiles in women (P<0.001) but not men. In contrast, covariate-adjusted LA size increased with worsening glucose tolerance and across HOMA-IR quartiles in the normal and abnormal glucose tolerance groups in both sexes. Adjustment for body mass index considerably attenuated the relations of LV/LA measures and HOMA-IR, rendering them statistically nonsignificant in the normal glucose tolerance group.
Conclusions— In our large community-based sample, LV mass and wall thickness increased with worsening glucose intolerance, an effect that was more striking in women compared with men. Insulin resistance was associated with increased LV mass in women alone, but this relation was largely accounted for by obesity.
Key Words: insulin • echocardiography • ventricle, left • hypertrophy, ventricular
This article has been cited by other articles:
 |
|
 |
|
  M.-G. Hong, C. Reynolds, M. Gatz, B. Johansson, J. C. Palmer, H. F. Gu, K. Blennow, P. G. Kehoe, U. de Faire, N. L. Pedersen, et al. Evidence that the gene encoding insulin degrading enzyme influences human lifespan Hum. Mol. Genet., August 1, 2008; 17(15): 2370 - 2378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Sundstrom, J Arnlov, K Stolare, and L Lind Blood pressure-independent relations of left ventricular geometry to the metabolic syndrome and insulin resistance: a population-based study Heart, July 1, 2008; 94(7): 874 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. D. Abel, S. E. Litwin, and G. Sweeney Cardiac Remodeling in Obesity Physiol Rev, April 1, 2008; 88(2): 389 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T H Marwick Diabetic heart disease Postgrad. Med. J., April 1, 2008; 84(990): 188 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. W.F. Wilson and J. B. Meigs Risk of type 2 diabetes mellitus and coronary heart disease: a pivotal role for metabolic factors Eur. Heart J. Suppl., March 1, 2008; 10(suppl_B): B11 - B15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. van Heerebeek, N. Hamdani, M. L. Handoko, I. Falcao-Pires, R. J. Musters, K. Kupreishvili, A. J.J. Ijsselmuiden, C. G. Schalkwijk, J. G.F. Bronzwaer, M. Diamant, et al. Diastolic Stiffness of the Failing Diabetic Heart: Importance of Fibrosis, Advanced Glycation End Products, and Myocyte Resting Tension Circulation, January 1, 2008; 117(1): 43 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Chess, B. Lei, B. D. Hoit, A. M. Azimzadeh, and W. C. Stanley Deleterious effects of sugar and protective effects of starch on cardiac remodeling, contractile dysfunction, and mortality in response to pressure overload Am J Physiol Heart Circ Physiol, September 1, 2007; 293(3): H1853 - H1860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. V. Leier and G. J. Haas Diabetes and Heart Failure: The Role of Thiazolidinediones in Managing These Partners in Crime J. Am. Coll. Cardiol., July 3, 2007; 50(1): 37 - 39. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Mitsuhashi, H. Yatsuya, K. Tamakoshi, K. Matsushita, R. Otsuka, K. Wada, K. Sugiura, S. Takefuji, Y. Hotta, T. Kondo, et al. Adiponectin Level and Left Ventricular Hypertrophy in Japanese Men Hypertension, June 1, 2007; 49(6): 1448 - 1454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Hopkins, N. Ouchi, R. Shibata, and K. Walsh Adiponectin actions in the cardiovascular system Cardiovasc Res, April 1, 2007; 74(1): 11 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Held, H.C. Gerstein, S. Yusuf, F. Zhao, L. Hilbrich, C. Anderson, P. Sleight, K. Teo, and for the ONTARGET/TRANSCEND Investigators Glucose Levels Predict Hospitalization for Congestive Heart Failure in Patients at High Cardiovascular Risk Circulation, March 20, 2007; 115(11): 1371 - 1375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sharma, I. C. Okere, M. K. Duda, D. J. Chess, K. M. O'Shea, and W. C. Stanley Potential impact of carbohydrate and fat intake on pathological left ventricular hypertrophy Cardiovasc Res, January 15, 2007; 73(2): 257 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Avelar, T. V. Cloward, J. M. Walker, R. J. Farney, M. Strong, R. C. Pendleton, N. Segerson, T. D. Adams, R. E. Gress, S. C. Hunt, et al. Left Ventricular Hypertrophy in Severe Obesity: Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass Hypertension, January 1, 2007; 49(1): 34 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Galderisi Diastolic Dysfunction and Diabetic Cardiomyopathy: Evaluation by Doppler Echocardiography J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1548 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Ingelsson, J Arnlov, L Lind, and J Sundstrom Metabolic syndrome and risk for heart failure in middle-aged men Heart, October 1, 2006; 92(10): 1409 - 1413. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Barsheshet, M. Garty, E. Grossman, A. Sandach, B. S. Lewis, S. Gottlieb, A. Shotan, S. Behar, A. Caspi, R. Schwartz, et al. Admission Blood Glucose Level and Mortality Among Hospitalized Nondiabetic Patients With Heart Failure. Arch Intern Med, August 14, 2006; 166(15): 1613 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, M. Pirro, G. Pucci, M. R. Mannarino, F. Gemelli, D. Siepi, G. Vaudo, and E. Mannarino Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women Hypertension, May 1, 2006; 47(5): 881 - 886. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. G. Poornima, P. Parikh, and R. P. Shannon Diabetic Cardiomyopathy: The Search for a Unifying Hypothesis Circ. Res., March 17, 2006; 98(5): 596 - 605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Bertoni, D. C. Goff Jr, R. B. D'Agostino Jr, K. Liu, W. G. Hundley, J. A. Lima, J. F. Polak, M. F. Saad, M. Szklo, R. P. Tracy, et al. Diabetic Cardiomyopathy and Subclinical Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care, March 1, 2006; 29(3): 588 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T H Marwick Diabetic heart disease Heart, March 1, 2006; 92(3): 296 - 300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Lazar Hyperglycemia during cardiac surgery J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 11 - 13. [Full Text] [PDF]
|
|
|
|
|
|
E. Ingelsson, J. Arnlov, J. Sundstrom, B. Zethelius, B. Vessby, and L. Lind Novel Metabolic Risk Factors for Heart Failure J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2054 - 2060. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kohsaka, R. R. Sciacca, K. Sugioka, R. L. Sacco, S. Homma, and M. R. Di Tullio Electrocardiographic Left Atrial Abnormalities and Risk of Ischemic Stroke Stroke, November 1, 2005; 36(11): 2481 - 2483. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Doenst, D. Wijeysundera, K. Karkouti, C. Zechner, M. Maganti, V. Rao, and M. A. Borger Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1144 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Liao, S. Takashima, N. Maeda, N. Ouchi, K. Komamura, I. Shimomura, M. Hori, Y. Matsuzawa, T. Funahashi, and M. Kitakaze Exacerbation of heart failure in adiponectin-deficient mice due to impaired regulation of AMPK and glucose metabolism Cardiovasc Res, September 1, 2005; 67(4): 705 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Burchfiel, T. N. Skelton, M. E. Andrew, R. J. Garrison, D. K. Arnett, D. W. Jones, and H. A. Taylor Jr Metabolic Syndrome and Echocardiographic Left Ventricular Mass in Blacks: The Atherosclerosis Risk in Communities (ARIC) Study Circulation, August 9, 2005; 112(6): 819 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ingelsson, J. Sundstrom, J. Arnlov, B. Zethelius, and L. Lind Insulin Resistance and Risk of Congestive Heart Failure JAMA, July 20, 2005; 294(3): 334 - 341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden The European Association for the Study of Diabetes Diabetes Care, May 1, 2005; 28(5): 1250 - 1257. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Ishizaka, Y. Ishizaka, E.-I. Toda, R. Nagai, and M. Yamakado Association Between Serum Uric Acid, Metabolic Syndrome, and Carotid Atherosclerosis in Japanese Individuals Arterioscler. Thromb. Vasc. Biol., May 1, 2005; 25(5): 1038 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Nielson and T. Lange Blood Glucose and Heart Failure in Nondiabetic Patients Diabetes Care, March 1, 2005; 28(3): 607 - 611. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Danias and N. A. Tritos Increased left ventricular mass in obese adolescents Eur. Heart J., January 2, 2005; 26(2): 201 - 202. [Full Text] [PDF]
|
|
|
|
|
|
N Wisniacki, W Taylor, M Lye, and J P H Wilding Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure Heart, January 1, 2005; 91(1): 32 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Y. Fang, J. B. Prins, and T. H. Marwick Diabetic Cardiomyopathy: Evidence, Mechanisms, and Therapeutic Implications Endocr. Rev., August 1, 2004; 25(4): 543 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Jessup and I. L. Pina Is it important to examine gender differences in the epidemiology and outcome of severe heart failure? J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1247 - 1252. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Davidoff, M. M. Mason, M. B. Davidson, M. W. Carmody, K. K. Hintz, L. E. Wold, D. A. Podolin, and J. Ren Sucrose-induced cardiomyocyte dysfunction is both preventable and reversible with clinically relevant treatments Am J Physiol Endocrinol Metab, May 1, 2004; 286(5): E718 - E724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M.A. Henry, O. Kamp, P. J. Kostense, A. M.W. Spijkerman, J. M. Dekker, R. van Eijck, G. Nijpels, R. J. Heine, L. M. Bouter, and C. D.A. Stehouwer Left Ventricular Mass Increases With Deteriorating Glucose Tolerance, Especially in Women: Independence of Increased Arterial Stiffness or Decreased Flow-Mediated Dilation: The Hoorn Study Diabetes Care, February 1, 2004; 27(2): 522 - 529. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. A. Harsch, S. P. Schahin, M. Radespiel-Troger, O. Weintz, H. Jahreiss, F. S. Fuchs, G. H. Wiest, E. G. Hahn, T. Lohmann, P. C. Konturek, et al. Continuous Positive Airway Pressure Treatment Rapidly Improves Insulin Sensitivity in Patients with Obstructive Sleep Apnea Syndrome Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 156 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Liu, M. R. Masurekar, D. E. Vatner, G. N. Jyothirmayi, T. J. Regan, S. F. Vatner, L. G. Meggs, and A. Malhotra Glycation end-product cross-link breaker reduces collagen and improves cardiac function in aging diabetic heart Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2587 - H2591. [Abstract] [Full Text] [PDF]
|
|