Abstract 3225: Implications of Prevalent and Incident Diabetes Mellitus on Left Ventricular Geometry and Function in the Ageing Heart: The MONICA/KORA Augsburg Study
BACKGROUND It is unclear whether diabetes mellitus, per se, causes structural or functional alterations of the heart.
METHODS We examined 1005 adults, aged 25 to 74 years, from a population-based survey at baseline in 1994/5 and at follow-up in 2004/5. Diabetes was defined as self-report, use of oral antidiabetics or insulin, or non-fasting glucose levels of 200mg/dl or more. We compared persistently non-diabetic individuals (ND; no diabetes at baseline and at follow-up, n=833) with incident (ID; non-diabetic at baseline and diabetic at follow-up, n=36) and with prevalent diabetics (PD; diabetes in baseline and follow-up examination, n=21). Left ventricular (LV) geometry and function were evaluated with echocardiography. Statistical analyses were performed with multivariate linear regression models.
RESULTS Over ten years, relative changes in LV wall thickness and relative wall thickness were similar in all three diabetic groups. The PD group displayed significantly stronger relative increases of LV end-diastolic diameter (+5.74% vs. +0.19%), LV mass (+21.6% vs. +9.8%), LV mass2.7 (+21.8% vs. +9.8%) and LA diameter (+10.8% vs. +4.6%) than the ND group, whereas ejection fraction decreased significantly (−5.4% and +2.9%, respectively). Results for ID individuals were intermediate between ND and PD. At the follow-up examination, ID and PD individuals showed a significantly less favorable E/EM ratio, as compared with the ND group (11.9 [p<0.001] and. 11.3 [p=0.010] vs. 9.85, respectively), while other indicators of diastolic dysfunction were similar. Finally, the adjusted odds ratio for cardiovascular disease was 3.24 (95% Confidence interval: 1.03 to 10.2) for the PD when compared with the ND group.
CONCLUSIONS Long-standing diabetes was associated with an acceleration of age-related changes of left ventricular geometry accentuating an eccentric remodeling of the left ventricle. Likewise, systolic and diastolic ventricular function deteriorated more rapidly in individuals with diabetes.