title: Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study.
abstract: BACKGROUND
  Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias.
  
  
  RESULTS
  We examined the relations between echocardiographic LV measurements and glucose tolerance status in 2623 Framingham Study subjects (1514 women, mean age 53 years) free of myocardial infarction and heart failure. We also evaluated the relations of insulin resistance (homeostasis model, HOMA-IR) and LV and left atrial (LA) measures within the normal and abnormal glucose tolerance categories (the latter included impaired glucose tolerance, impaired fasting glucose, and newly diagnosed diabetes). LV mass (adjusted for age, height, heart rate, and systolic blood pressure) increased across categories of worsening glucose tolerance; the trend was more striking in women (P<0.001) compared with men (P=0.054). In subjects with normal (n=2022) and abnormal glucose tolerance (n=327), covariate-adjusted LV mass and LV wall thickness increased across HOMA-IR quartiles in women (P<0.001) but not men. In contrast, covariate-adjusted LA size increased with worsening glucose tolerance and across HOMA-IR quartiles in the normal and abnormal glucose tolerance groups in both sexes. Adjustment for body mass index considerably attenuated the relations of LV/LA measures and HOMA-IR, rendering them statistically nonsignificant in the normal glucose tolerance group.
  
  
  CONCLUSIONS
  In our large community-based sample, LV mass and wall thickness increased with worsening glucose intolerance, an effect that was more striking in women compared with men. Insulin resistance was associated with increased LV mass in women alone, but this relation was largely accounted for by obesity.
authors.affiliation: Framingham Heart Study, Burlington, Mass, USA.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.forename: Richard W
authors.initials: RW
authors.lastname: Nesto
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005951:Glucose Tolerance Test; D006325:Heart Atria / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012737:Sex Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left