Implications of prevalent and incident diabetes mellitus on left ventricular geometry and function in the ageing heart: The MONICA/KORA Augsburg cohort study☆
Received 22 September 2008; received in revised form 4 June 2009; accepted 10 September 2009. published online 27 November 2009. Corrected Proof
Abstract
Background and Aim
It is unclear to what extent diabetes modulates the ageing-related adaptations of cardiac geometry and function.
Methods and Results
We examined 1005 adults, aged 25–74 years, from a population-based survey at baseline in 1994/5 and at follow-up in 2004/5. 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 at baseline and follow-up examination, n=21). Left ventricular (LV) geometry and function were evaluated by echocardiography. Statistical analyses were performed with multivariate linear regression models.
Over ten years the PD group displayed a significantly stronger relative increase of LV mass (+9.34% vs. +23.7%) that was mediated by a more pronounced increase of LV end-diastolic diameter (+0% vs. +6.95%) compared to the ND group. In parallel, LA diameter increased (+4.50% vs. +12.7%), whereas ejection fraction decreased (+3.02% vs. −4.92%) more significantly in the PD group. Moreover, at the follow-up examination the PD and ID groups showed a significantly worse diastolic function, indicated by a higher E/EM ratio compared with the ND group (11.6 and 11.8 vs. 9.79, respectively).
Conclusions
Long-standing diabetes was associated with an acceleration of age-related changes of left ventricular geometry accumulating in an eccentric remodelling of the left ventricle. Likewise, echocardiographic measures of systolic and diastolic ventricular function deteriorated more rapidly in individuals with diabetes.
aInstitute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
bMedical Clinic II, University of Lübeck Medical School, Lübeck, Germany
cHeart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
dSection Epidemiology of Health Care and Community Health, Institute of Community Medicine, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
eClinic and Policlinic for Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
fInstitute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
Corresponding author. Medical Clinic II, University of Lübeck Medical School, Ratzeburger Allee, 160, D-23538 Lübeck, Germany. Tel.: +49 451 500 2501; fax: +49 451 500 6437.
☆ For the MONICA/KORA investigators. The MONICA Augsburg Study was initiated and conducted by Ulrich Keil and coworkers. The KORA Group consists of H.E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John and their coworkers who are responsible for the design and conduct of the KORA studies.
ABSTRACT
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