Abstract 3224: Metabolic and Cardiovascular Characteristics of Diabetics in Adolescents and Young Adults: the Strong Heart Study
BACKGROUND: The epidemic of overweight is increasing prevalence of diabetes (DM) in adolescents and young adults, but few population-based data exist on early metabolic and cardiovascular impact of DM.
METHODS: We analyzed clinical characteristics, hemodynamics, left ventricular (LV) geometry and function (by Doppler-echocardiography) in 1644, 14-to-39 year old participants (57% female), at the 4th Strong Heart Study (SHS) examination, 173 (11%) of whom had DM. Comparison between groups was obtained by ANCOVA, adjusting for blood pressure (BP), age, gender and BMI.
RESULTS: Participants with DM were more often obese (80% versus 51%), older (age 32±6 versus 26±8 years), and hypertensive (44% versus 14%). Dyslipidemia (84% versus 54%) and proteinuria (microalbuminuria: 34% versus 8%; macroalbuminuria: 15% versus 0.7%) were also more frequent in DM(all P<0.0001 versus non diabetic participants [ND]). After adjustment for covariates, participants with DM had higher LV relative wall thickness than their ND counterparts (0.31 versus 0.30 p=0.007), higher cardiac output (5.7 versus 5.2 l/min, p<0.0001), LV elastance (mean arterial BP/LV end-systolic volume: 2.00 versus 1.89, p=0.01), arterial elastance (mean BP/stroke volume: 1.19 versus 1.14, p=0.03) and central pulse pressure (39.4 versus 37.8 mmHg, p<0.0001), and lower stroke volume/central pulse pressure ratio (2.02 versus 2.10 ml/beat/mm Hg, p=0.01) and lower total peripheral resistance (1311 versus 1412 dynes*sec*cm-5, p< 0.0001). Participants with DM also had higher transmitral A velocity, longer isovolumic relaxation time and lower transmitral E/A ratio than ND (all<0.001), without significant differences for other echocardiographic variables.
CONCLUSIONS: Among adolescent and young adult SHS participants, with high prevalence of obesity, DM is associated with early metabolic abnormalities and unfavorable cardiovascular alterations.