Abstract 14200: The Association Between Markers of Preclinical Cardiovascular Disease and Incident Diabetes is Mediated by the Insulin Resistance Syndrome: The Strong Heart Study
Introduction: Hypertensive left ventricular [LV] hypertrophy (LVH) precedes and independently predicts incident type 2 diabetes (DM).
Hypothesis: Target organ damage (TOD, i.e. LVH and urinary albumin/creatinine excretion [UACr]) precede incident DM in a population-based cohort, independently of measures of adiposity, body composition and circulating insulin.
Methods: We assess 4-year predictors of DM in non-diabetic participants (ADA criteria) from the Strong Heart Study (2nd exam) and the Strong Heart Family Study (4th exam), in relation to initial glucose profile (i.e., normal [NFG] or impaired fasting glucose [IFG]), obesity, central fat distribution (by waist circumference), body composition (by bioelectric impedance analysis), and markers of TOD.
Results: Of 3385 participants, 235 died during follow-up and 263 were unclassified at the follow-up. Thus, after 4 years, the glucose status was available in 2887 participants (1721 or 60% women; median age=48 yrs, IQR=30-57 yrs, range=14-93 yrs; 37% with IFG at baseline, 36% hypertensive, 47% obese, 63% with central fat distribution). At follow-up, 20% with baseline IFG had DM vs 4% of participants with NFG (p<0.0001). After adjusting for age, sex, field center and kinship coefficient (to rule out possible relatedness effects), incident DM was more frequent in participants with LVH (p<0.0001) and higher UACr (p<0.04). Association with UACr became insignificant and that with LVH was attenuated (OR from 1.89 to 1.68, p<0.002) when controlling for hypertension (p<0.06) and initial glucose status (p<0.0001). Association of incident DM with LVH disappeared (OR=1.18) when controlling for obesity (p<0.003) and initial log of insulin levels (p<0.0001), with borderline significance of the amount of body fat (p=0.07). Central fat distribution was not associated with incident diabetes independently of the amount of body fat.
Conclusions: TOD conventionally attributed to diabetes precedes its clinical appearance. This association substantially depends on obesity-related abnormalities. Substantial part of the TOD attributable to diabetes is due to metabolic alterations related to the preceding obesity and insulin resistance.
Author Disclosures: G. de Simone: None. W. Wang: None. L.G. Best: None. F. Yeh: None. R. Izzo: None. M. J. Roman: None. E. T Lee: None. B. V. Howard: None. R. B. Devereux: None.
- © 2016 by American Heart Association, Inc.