Prognostic implications of fasting plasma glucose in subjects with echocardiographic abnormalities.
OBJECTIVE
To examine whether baseline fasting plasma glucose (FPG) modifies the prognostic role of left ventricular (LV) mass, geometric pattern, and diastolic function, for prediction of cardiovascular morbidity and mortality.


METHODS
Population-based cohort study comprising of 1047 men and 456 women with preserved ejection fraction, included between 2002 and 2006, who underwent echocardiography based on groups defined by FPG, measured prior to echocardiography. The clinical endpoint was the composite of cardiovascular events and all-cause mortality, assessed through national and local registries. Cox proportional-hazards regression with interaction analysis was used to evaluate the risk associated with FPG and LV structure and function.


RESULTS
Median age was 67years, and 31% had impaired fasting glucose, 31% diabetes, 17% LV hypertrophy, and 40% diastolic dysfunction. During a median follow-up duration of 8.3years, 449 composite events occurred. FPG (hazard ratio (HR), 1.09 (95% confidence interval (CI): 1.05-1.13), P<0.001) and several markers of LV structure and function, including LV mass index (HR, 1.10 (95% CI: 1.06-1.15), P<0.001) and E/é (HR, 1.08 (95% CI 1.05-1.10), P<0.001) were associated with an increased risk of events. In the subgroup of 678 individuals without previous cardiovascular disease, who did not receive cardiovascular, anti-diabetic, or lipid-lowering medication, FPG significantly interacted with the association between concentric LV hypertrophy and event risk (P<0.001), and with the association between diastolic dysfunction and event risk (P=0.02), including grade 2 or 3 dysfunction (P=0.04).


CONCLUSIONS
Echocardiographic abnormalities were more strongly associated with an adverse prognosis among subjects with impaired fasting glucose or diabetes.
Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Sdr. Boulevard 29, Odense University Hospital, 5000 Odense C, Denmark; Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: mananpareek@dadlnet.dk.
Manan
M
Pareek
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Muthiah
M
Vaduganathan
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Deepak L
DL
Bhatt
Department of Cardiology, Skåne University Hospital, Södra Förstadsgatan 101, 205 02 Malmö, Sweden.
Margrét
M
Leósdóttir
Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Sdr. Boulevard 29, Odense University Hospital, 5000 Odense C, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
Michael H
MH
Olsen
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology
D001786:Blood Glucose
Diabetes mellitus; Diastolic dysfunction; Impaired fasting glucose; Left ventricular hypertrophy