title: Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricular mass in a supra-additive fashion in an elderly, healthy, Swedish population.
abstract: OBJECTIVE
  To examine whether increasing fasting plasma glucose (FPG) levels were associated with worsening left ventricular (LV) diastolic function, independently of LV mass index (LVMI) in elderly, otherwise healthy subjects.
  
  
  RESULTS
  We tested cross-sectional associations between echocardiographically determined averaged E/é ratio/diastolic function, LVMI, cardiovascular risk factors, and FPG categorized as normal (NFG), impaired (IFG), and new-onset diabetes mellitus (DM), in 483 men and 208 women aged 56-79 years without overt cardiovascular disease, who received no cardiovascular, anti-diabetic, or lipid-lowering drugs and had a preserved LV ejection fraction >50%. Median E/é was significantly higher among subjects with diabetes than those without (8 vs. 7; p = 0.03), as was the prevalence of grade 2 or 3 diastolic dysfunction (25% vs. 16%; p = 0.02). E/é and diastolic function were significantly associated with LVMI (p ≤ 0.002), but not FPG category, on multivariable analysis. However, interaction analyses revealed that increasing LVMI was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG > 6 mmol/L (β=0.005 for IFG and DM vs. 0.001 for NFG; p = 0.02), whereas increasing systolic blood pressure was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG ≤ 6.9 mmol/L (β = 0.005 for NFG and 0.003 for IFG vs. -0.001 for DM; p=0.001).
  
  
  CONCLUSIONS
  Diastolic dysfunction was significantly more prevalent among patients with DM than those without. The importance of LVMI increased, but the importance of systolic blood pressure decreased with higher FPG category.
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark. Electronic address: mananpareek@dadlnet.dk.
authors.forename: Manan
authors.initials: M
authors.lastname: Pareek
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark.
authors.forename: Mette Lundgren
authors.initials: ML
authors.lastname: Nielsen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Margrét
authors.initials: M
authors.lastname: Leósdóttir
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Jacob Eifer
authors.initials: JE
authors.lastname: Møller
authors.affiliation: Department of Clinical Biochemistry, Holstebro Hospital, Holstebro, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hindersson
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Thomas Berend
authors.initials: TB
authors.lastname: Sehestedt
authors.affiliation: Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
authors.forename: Michael Hecht
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods; D005215:Fasting / Q000097:blood; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D054144:Heart Failure, Diastolic / Q000097:blood / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013223:Statistics as Topic; D013548:Sweden / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: Asymptomatic diastolic dysfunction; Diabetes mellitus; E/é; Fasting plasma glucose; Left ventricular mass index