title: Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study.
abstract: This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood.
  
  
  
  Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life.
  
  
  
  In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction.
  
  
  
  The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A1cwere independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level.
  
  
  
  Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kishi
authors.affiliation: A.I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Gidding
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Jared P
authors.initials: JP
authors.lastname: Reis
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Bharath A
authors.initials: BA
authors.lastname: Venkatesh
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Anderson C
authors.initials: AC
authors.lastname: Armstrong
authors.affiliation: Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Isogawa
authors.affiliation: University of Alabama, Birmingham, Alabama.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Colin
authors.initials: C
authors.lastname: Wu
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Johns Hopkins University, Baltimore, Maryland. Electronic address: jlima@jhmi.edu.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D001786:Blood Glucose / Q000378:metabolism*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D018149:Glucose Intolerance / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009765:Obesity / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: diabetes mellitus; echocardiography; insulin resistance; left ventricular function; obesity; speckle-tracking echocardiography