title: Association of Impaired Glucose Regulation and Insulin Resistance With Cardiac Structure and Function: Results From ECHO-SOL (Echocardiographic Study of Latinos).
abstract: BACKGROUND
  We examined the relationship between glucose homeostasis and comprehensive measures of cardiac structure and function among a representative sample of US Hispanics.
  
  
  RESULTS
  ECHO-SOL (Echocardiographic Study of Latinos), an echocardiographic ancillary study of the HCHS/SOL (Hispanic Community Health Study/Study of Latinos), enrolled 1818 Hispanic/Latino men (43%) and women (57%) aged ≥45 years (mean=56). Glucose intolerance was defined as follows: (1) prediabetes: hemoglobin (HbA1c) ≥5.7 and <6.5% and (2) diabetes mellitus: fasting plasma glucose ≥126 mg/dL, 2-hour postload glucose ≥200 mg/dL, HbA1c ≥6.5%, or hypoglycemic agent use. Uncontrolled diabetes mellitus was defined as HbA1c ≥7.0%. Insulin resistance was defined using the homeostatic model assessment for insulin resistance. Echocardiography examinations assessed left ventricular structure and systolic/diastolic function. Multivariable linear and logistic regression models were used. Prediabetes prevalence was 42%, and diabetes mellitus prevalence was 28% (47% uncontrolled). Glucose intolerance was associated with increased left ventricular posterior wall and interventricular septal and relative wall thicknesses (all P<0.05), reduced ejection fraction (P<0.01), reduced stroke and end-diastolic volumes (both P<0.001), decreased peak E' velocity (lateral and septal P<0.001), and increased E/E' ratio (lateral and septal P<0.01). The odds ratios (95% confidence intervals) for diastolic dysfunction among individuals with prediabetes and diabetes mellitus (versus diabetes mellitus free) were 1.36 (0.96-1.9) and 1.90 (1.3-2.8), respectively(P=0.006). Results were consistent for uncontrolled diabetes mellitus versus diabetes mellitus. Homeostatic model assessment for insulin resistance was associated with increased E/E' (P<0.001), and greater relative wall thickness and septal thickness (both P<0.05); lower stroke volume (P<0.0001); and lower peak lateral and septal E' velocities (both P<0.01).
  
  
  CONCLUSIONS
  Glucose intolerance and insulin resistance are associated with unfavorable cardiac structure and function, particularly worsened measures of diastolic function, even before the development of diabetes mellitus.
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.). rtd2106@cumc.columbia.edu.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Jianwen
authors.initials: J
authors.lastname: Cai
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Ankit A
authors.initials: AA
authors.lastname: Desai
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Barry E
authors.initials: BE
authors.lastname: Hurwitz
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Jill C
authors.initials: JC
authors.lastname: Newman
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Katrina
authors.initials: K
authors.lastname: Swett
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Talavera
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Ashley
authors.initials: A
authors.lastname: Thai
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Marston E
authors.initials: ME
authors.lastname: Youngblood
authors.affiliation: From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (R.T.D., A.T.); Department of Family Medicine and Public Health (M.A.A.) and Graduate School of Public Health (G.A.T.), University of California, San Diego; Department of Biostatistics, University of North Carolina at Chapel Hill (J.C., M.E.Y.); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY (R.C.K.); Department of Medicine, University of Illinois, Champaign (A.A.D.); Department of Psychology, Behavioral Medicine Research Center, University of Miami, Coral Gables, FL (B.E.H.); Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (J.C.N., K.S., C.J.R.); and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.).
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino; D006801:Humans; D007333:Insulin Resistance / Q000208:ethnology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes mellitus; diabetic cardiomyopathy; echocardiography; insulin resistance; prediabetic state