Abstract
Objectives
To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular
diseases in a community population.
Patients & Methods
Cross-sectional survey of residents randomly selected through the Rochester Epidemiology
Project, 45 years or older, of Olmsted County as of June 1, 1997, through September
30, 2000. Responders (2042) underwent assessment of systolic and diastolic function
using echocardiography. The current analyses included all participants with DM and
were compared with a group of participants without DM matched 1:2 for age, sex, hypertension,
and coronary artery disease. Baseline characteristics and laboratory and echocardiography
findings between groups were compared along with rates of mortality due to various
cardiovascular conditions.
Results
We identified 116 participants with DM and 232 matched participants without DM. Those
with DM had a higher body mass index and plasma insulin and serum glucose levels.
Although left ventricular ejection fractions were similar, E/e' ratio (9.7 vs 8.5;
P=.001) was higher in DM vs non-DM. During a follow-up of 10.8 (interquartile range,
7.8-11.7) years, participants with DM had a higher incidence of heart failure (HF);
hazard ratio, 2.1; 95% confidence limits, 1.2-3.6; P=.01) and 10-year Kaplan-Meier rate of 21% (22 of 116) vs 12% (24 of 232) compared
with those without DM. We also examined the subgroup of participants without diastolic
dysfunction. In this subgroup, those with DM had an increased risk for HF; hazard
ratio, 2.5; 95% confidence limits, 1.0-6.3; P=.04).
Conclusion
In this cohort, participants with DM have an increased incidence of HF over a 10-year
follow-up period even in the absence of underlying diastolic dysfunction. These findings
suggest that DM is an independent risk factor for the development of HF and supports
the concept of DM cardiomyopathy.
Abbreviations and Acronyms:
BMI (body mass index), CAD (coronary artery disease), DCM (diabetic cardiomyopathy), DM (diabetes mellitus), E (passive transmitral left ventricular inflow velocity), e′ (tissue Doppler imaging velocity of the medial mitral annulus during passive filling), EF (ejection fraction), HF (heart failure), HR (hazard ratio), HTN (hypertension), LA (left atrial), LV (left ventricular), MI (myocardial infarction), NT-proBNP (N-terminal prohormone of brain natriuretic peptide), REP (Rochester Epidemiology Project), ROS (reactive oxygen species)To read this article in full you will need to make a payment
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Article Info
Footnotes
Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676 ; Principal Investigators: Walter A. Rocca, MD, MPH, and Jennifer L. St Sauver, PhD). The design and conduct of the study and collection, management, analysis, and interpretation of the data were supported by grants from the National Institutes of Health ( P01 HL76611 , R01HL84155 , and R01-HL136440 to H.H.C. and HL RO1-55502 to R.J.R).
Potential Competing Interests: H.H.C. is co-founder of Zumbro Discovery. There are no other financial or other relations that could lead to a conflict of interest in the context of this paper.
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