title: Cardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk In the Community study.
abstract: BACKGROUND
  Individuals with diabetes mellitus and pre-diabetes mellitus are at particularly high risk of incident heart failure or death, even after accounting for known confounders. Nevertheless, the extent of impairments in cardiac structure and function in elderly individuals with diabetes mellitus and pre-diabetes mellitus is not well known. We aimed to assess the relationship between echocardiographic measures of cardiac structure and function and dysglycemia.
  
  
  RESULTS
  We assessed measures of cardiac structure and function in 4419 participants without prevalent coronary heart disease or heart failure who attended the Atherosclerosis Risk In the Community (ARIC) visit 5 examination (2011-2013) and underwent transthoracic echocardiography (age, 75±6 years; 61% women, 23% black). Subjects were grouped across the dysglycemia spectrum as normal (39%), pre-diabetes mellitus (31%), or diabetes mellitus (30%) based on medical history, antidiabetic medication use, and glycated hemoglobin levels. Glycemic status was related to measures of cardiac structure and function. Worsening dysglycemia was associated with increased left ventricular mass, worse diastolic function, and subtle reduction in left ventricular systolic function (P≤0.01 for all). For every 1% higher glycated hemoglobin, left ventricular mass was higher by 3.0 g (95% confidence interval, 1.5-4.6 g), E/E' by 0.5 (95% confidence interval, 0.4-0.7), and global longitudinal strain by 0.3% (95% confidence interval, 0.2-0.4) in multivariable analyses.
  
  
  CONCLUSIONS
  In a large contemporary biracial cohort of elderly subjects without prevalent cardiovascular disease or heart failure, dysglycemia was associated with subtle and subclinical alterations of cardiac structure, and left ventricular systolic and diastolic function. It remains unclear whether these are sufficient to explain the heightened risk of heart failure in individuals with diabetes mellitus.
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.). hskali@post.harvard.edu.
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Amil
authors.initials: A
authors.lastname: Shah
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Jiankang
authors.initials: J
authors.lastname: Liu
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Natalie
authors.initials: N
authors.lastname: Bello
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Orly
authors.initials: O
authors.lastname: Vardeny
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013599:Systole; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: cardiomyopathies; diabetes mellitus; echocardiography