title: Diabetic cardiomyopathy and subclinical cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  Studies have demonstrated increased left ventricular mass (LVM) and diastolic dysfunction among diabetic patients without clinical cardiovascular disease (CVD), but few have assessed the potential contribution of subclinical CVD to ventricular abnormalities in diabetes. We examined whether diabetic cardiomyopathy is associated with subclinical atherosclerosis and if abnormalities are found with impaired fasting glucose (IFG).
  
  
  METHODS
  LVM, end-diastolic volume (EDV), and stroke volume were measured by magnetic resonance imaging (MRI), and atherosclerosis was assessed by coronary artery calcium and carotid intima-media wall thickness in 4,991 participants in the Multi-Ethnic Study of Atherosclerosis, a cohort study of adults aged 45-84 without prior CVD. Multivariable linear regression was used to analyze the association between MRI measures and glucose status.
  
  
  RESULTS
  Increased LVM was observed in white, black, and Hispanic participants with diabetes but not among Chinese participants. After adjustment for weight, height, CVD risk factors, and subclinical atherosclerosis, ethnicity-specific differences in ventricular parameters were present. Among whites and Chinese with diabetes, LVM was similar to that in normal subjects; EDV and stroke volume were reduced. In blacks with diabetes, EDV and stroke volume were reduced, and LVM was increased (+5.6 g, P < 0.05). Among Hispanics with diabetes, EDV and stroke volume were similar to normal, but LVM was increased (+5.5 g, P < 0.05). After adjustment, IFG was associated with a decrease in EDV and stroke volume in whites and blacks only; however, no significant differences in LVM were observed.
  
  
  CONCLUSIONS
  Ethnicity-specific differences in LVM, EDV, and stroke volume are associated with abnormal glucose metabolism and are independent of subclinical CVD.
authors.affiliation: Wake Forest University Health Sciences, Department of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA. abertoni@wfubmc.edu
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
authors.forename: Joao A
authors.initials: JA
authors.lastname: Lima
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Saad
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D044383:Black People; D009202:Cardiomyopathies / Q000208:ethnology* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000209:etiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000208:ethnology / Q000209:etiology; D048909:Diabetes Complications / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044465:White People