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Hoek AG, Dal Canto E, Wenker E, Bindraban N, Handoko ML, Elders PJM, Beulens JWJ. Epidemiology of heart failure in diabetes: a disease in disguise. Diabetologia 2024; 67:574-601. [PMID: 38334818 PMCID: PMC10904471 DOI: 10.1007/s00125-023-06068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 02/10/2024]
Abstract
Left ventricular diastolic dysfunction (LVDD) without symptoms, and heart failure (HF) with preserved ejection fraction (HFpEF) represent the most common phenotypes of HF in individuals with type 2 diabetes mellitus, and are more common than HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and left ventricular systolic dysfunction (LVSD) in these individuals. However, diagnostic criteria for HF have changed over the years, resulting in heterogeneity in the prevalence/incidence rates reported in different studies. We aimed to give an overview of the diagnosis and epidemiology of HF in type 2 diabetes, using both a narrative and systematic review approach; we focus narratively on diagnosing (using the 2021 European Society of Cardiology [ESC] guidelines) and screening for HF in type 2 diabetes. We performed an updated (2016-October 2022) systematic review and meta-analysis of studies reporting the prevalence and incidence of HF subtypes in adults ≥18 years with type 2 diabetes, using echocardiographic data. Embase and MEDLINE databases were searched and data were assessed using random-effects meta-analyses, with findings presented as forest plots. From the 5015 studies found, 209 were screened using the full-text article. In total, 57 studies were included, together with 29 studies that were identified in a prior meta-analysis; these studies reported on the prevalence of LVSD (n=25 studies, 24,460 individuals), LVDD (n=65 studies, 25,729 individuals), HFrEF (n=4 studies, 4090 individuals), HFmrEF (n=2 studies, 2442 individuals) and/or HFpEF (n=8 studies, 5292 individuals), and on HF incidence (n=7 studies, 17,935 individuals). Using Hoy et al's risk-of-bias tool, we found that the studies included generally had a high risk of bias. They showed a prevalence of 43% (95% CI 37%, 50%) for LVDD, 17% (95% CI 7%, 35%) for HFpEF, 6% (95% CI 3%, 10%) for LVSD, 7% (95% CI 3%, 15%) for HFrEF, and 12% (95% CI 7%, 22%) for HFmrEF. For LVDD, grade I was found to be most prevalent. Additionally, we reported a higher incidence rate of HFpEF (7% [95% CI 4%, 11%]) than HFrEF 4% [95% CI 3%, 7%]). The evidence is limited by the heterogeneity of the diagnostic criteria over the years. The systematic section of this review provides new insights on the prevalence/incidence of HF in type 2 diabetes, unveiling a large pre-clinical target group with LVDD/HFpEF in which disease progression could be halted by early recognition and treatment.Registration PROSPERO ID CRD42022368035.
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Affiliation(s)
- Anna G Hoek
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Elisa Dal Canto
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eva Wenker
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Navin Bindraban
- Heartcenter, Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - M Louis Handoko
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Heartcenter, Department of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
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2
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Bingöl G, Avcı Demir F, Özmen E, Ünlü S, Özden Ö, Tokdil KO, Arsoy LB, Özpamuk Karadeniz F, Ökçün B. Effects of an Impaired Fasting Glucose on the Left Atrial Strain Evaluated by Speckle Tracking Echocardiography. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1982. [PMID: 38004031 PMCID: PMC10672977 DOI: 10.3390/medicina59111982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Similar to diabetes, the presence of left ventricular (LV) diastolic function (DD) has been reported in various studies which were conducted with people with a diagnosis of an impaired fasting blood glucose (FBG). This study aimed to examine the effects of the fasting blood glucose (FBG) levels on the left atrial strain (LAS) estimated by two-dimensional echocardiography speckle tracking analyses in patients without known diabetes. Material and Methods: The study included 148 participants (74 female and 74 male) without a history of diabetes mellitus or chronic disease. The patients were divided into two groups as follows: individuals with an FBG < 100 mg/dL and those with an FBG between 100 and 125 mg/dL after at least 8 h of overnight fasting. According to these FBG levels, speckle tracking echocardiography (STE) measures were compared. Results: There was a significant decrease in the LA reservoir (52.3 ± 15 vs. 44.5 ± 10.7; p = 0.001) and conduit strain (36.9 ± 11.7 vs. 28.4 ± 9.7; p = 0.001) in the impaired FBG group. When the STE findings of both ventricles were compared, no significant difference was observed between the groups in right and left ventricular strain imaging. Conclusions: In the earliest stage of LVDD, changes in atrial functional parameters become particularly evident. Echocardiographic analyses of these parameters can help to diagnose and determine the degree of LVDD while the morphological parameters are still normal. The addition of LAS imaging to routine transthoracic echocardiography (TTE) studies in patients with an impaired FBG but without a DM diagnosis may be helpful in demonstrating subclinical LVDD or identifying patients at risk for LVDD in this patient group.
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Affiliation(s)
- Gülsüm Bingöl
- Department of Cardiology, Istanbul Arel University, 34537 Istanbul, Turkey;
| | - Fulya Avcı Demir
- Department of Cardiology, Antalya Medical Park Hospital, 07160 Antalya, Turkey;
| | - Emre Özmen
- Memorial Bahçelievler Hospital, 34180 Istanbul, Turkey; (E.Ö.); (Ö.Ö.); (B.Ö.)
| | - Serkan Ünlü
- Department of Cardiology, Gazi University Faculty of Medicine, 06570 Ankara, Turkey;
| | - Özge Özden
- Memorial Bahçelievler Hospital, 34180 Istanbul, Turkey; (E.Ö.); (Ö.Ö.); (B.Ö.)
| | | | - Leyla Bulut Arsoy
- Department of Biochemistry, İstanbul Göztepe Prof Dr. Süleyman Yalçın City Hospital, 34722 İstanbul, Turkey;
| | - Fatma Özpamuk Karadeniz
- Department of Cardiology, Medical Faculty, Karamanoğlu Mehmetbey University, 70100 Karaman, Turkey
| | - Barış Ökçün
- Memorial Bahçelievler Hospital, 34180 Istanbul, Turkey; (E.Ö.); (Ö.Ö.); (B.Ö.)
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3
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Zheng C, Chen Z, Zhang L, Wang X, Dong Y, Wang J, Shao L, Tian Y, Wang Z. Metabolic Risk Factors and Left Ventricular Diastolic Function in Middle-Aged Chinese Living in the Tibetan Plateau. J Am Heart Assoc 2020; 8:e010454. [PMID: 30871396 PMCID: PMC6475067 DOI: 10.1161/jaha.118.010454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Data regarding the metabolic risk factors clustering on the risk of left ventricular diastolic dysfunction (LVDD) are lacking among people living at high altitude and under hypoxic conditions. In this study, we explored the association between metabolic risk factor clustering and LVDD among the Tibetan population of China. Methods and Results We conducted a cross‐sectional survey in a representative sample of 1963 Tibetans in 2014 to 2016. Grading LVDD was based on recommendations for the evaluation of LV diastolic function by echocardiography (2009). The prevalence of LVDD among 1963 participants (mean age: 51.51 years, 41.11% male) was 34.39%. Odds ratios (95% CI) of LVDD for the 1, 2, and 3 to 5 risk factors clustering were 1.45 (0.96–2.17), 2.68 (1.8–3.98), and 2.9 (1.9–4.43), respectively (P for trend <0.001). The association between metabolic risk factors clustering and LVDD was much more pronounced in the middle‐aged group than in the elderly (P for interaction=0.0170). High altitude was one of the major independent risk factors for LVDD; however, habitation altitude had no significant effect on the association between metabolic risk factors and LVDD (P for interaction=0.1022). The multivariable dominance analysis indicated that abdominal obesity, hypertension, and elevated blood glucose were the significant contributors to LVDD. Conclusions There was a significant positive association between the metabolic risk factor clustering number and LVDD among a population living at high altitude, especially in middle‐aged adults. However, habitation altitude itself has no significant effect on the association between metabolic risk factors and LVDD.
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Affiliation(s)
- Congyi Zheng
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Zuo Chen
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Linfeng Zhang
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Xin Wang
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Ying Dong
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Jiali Wang
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Lan Shao
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Ye Tian
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
| | - Zengwu Wang
- 1 State Key Laboratory of Cardiovascular Disease National Clinical Research Center of Cardiovascular Disease Division of Prevention and Community Health National Center for Cardiovascular Disease Fuwai Hospital Peking Union Medical College & Chinese Academy of Medical Sciences Beijing China
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4
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Pareek M, Olsen MH. Making sense of subclinical cardiac alterations in patients with diabetes. Bosn J Basic Med Sci 2019; 19:312-314. [PMID: 31394053 DOI: 10.17305/bjbms.2019.4349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/06/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with diabetes are prone to develop a distinct primary myocardial condition, diabetic cardiomyopathy, placing them at an increased risk for heart failure (1-3). This occurs independently of hypertension, coronary artery disease, and other established causes of heart failure. Pertinent findings include increased mass, concentric changes, and diastolic dysfunction of the left ventricle (4,5). Such adverse remodeling is common among patients with diabetes and appears to be strongly associated with its duration, suggesting a role for persistent metabolic stress (6-8). However, which exact components of the diabetic syndrome determine these cardiac alterations is not clear. Moreover, most studies have investigated patients with type 2 diabetes, and it is uncertain whether patients with type 1 diabetes experience similar myocardial changes.
Continue reading full text in the preliminary PDF version.
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Affiliation(s)
- Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA.
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5
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Bouthoorn S, Valstar GB, Gohar A, den Ruijter HM, Reitsma HB, Hoes AW, Rutten FH. The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis. Diab Vasc Dis Res 2018; 15:477-493. [PMID: 30037278 PMCID: PMC6236645 DOI: 10.1177/1479164118787415] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Type 2 diabetes is a risk factor for the development of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction. Our aim was to provide a summary estimate of the prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in type 2 diabetes patients and to investigate sex disparities. METHODS AND RESULTS A systematic search of the databases Medline and Embase was conducted for studies reporting the prevalence of left ventricular diastolic dysfunction or heart failure with preserved ejection fraction among type 2 diabetes patients. Studies were only included if echocardiography was performed. Prevalence estimates were pooled using random-effects meta-analysis. A total of 28 studies were included. Data on the prevalence of left ventricular diastolic dysfunction were available in 27 studies. The pooled prevalence for left ventricular diastolic dysfunction in the hospital population (2959 type 2 diabetes participants) and in the general population (2813 type 2 diabetes participants) was 48% [95% confidence interval: 38%-59%] and 35% (95% confidence interval: 24%-46%), respectively. Heterogeneity was high in both populations, with estimates ranging from 19% to 81% in the hospital population and from 23% to 54% in the general population. For women and men, the pooled prevalence estimates of left ventricular diastolic dysfunction were 47% (95% confidence interval: 37%-58%) and 46% (95% confidence interval: 37%-55%), respectively. Only two studies presented the prevalence of heart failure with preserved ejection fraction; 8% (95% confidence interval: 5%-14%) in a hospital population and 25% (95% confidence interval: 21%-28%) in the general population [18% in men (mean age: 73.8; standard deviation: 8.6) and 28% in women (mean age: 74.9; standard deviation: 6.9)]. CONCLUSION The prevalence of left ventricular diastolic dysfunction among type 2 diabetes patients is similarly high in men and women, while heart failure with preserved ejection fraction seems to be more common in women than men, at least in community people with type 2 diabetes.
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Affiliation(s)
- Selma Bouthoorn
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
| | - Gideon B Valstar
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
- Department of Experimental Cardiology,
University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
- Gideon B Valstar, Department of Experimental
Cardiology, University Medical Center Utrecht, Utrecht University, P.O. Box
85500, Utrecht 3508 AB, The Netherlands.
| | - Aisha Gohar
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
- Department of Experimental Cardiology,
University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
| | - Hester M den Ruijter
- Department of Experimental Cardiology,
University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
| | - Hans B Reitsma
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and
Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The
Netherlands
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6
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Świerblewska E, Wolf J, Kunicka K, Graff B, Polonis K, Hoffmann M, Chrostowska M, Szyndler A, Bandosz P, Graff B, Narkiewicz K. Prevalence and distribution of left ventricular diastolic dysfunction in treated patients with long-lasting hypertension. Blood Press 2018; 27:376-384. [PMID: 30129379 DOI: 10.1080/08037051.2018.1484661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although the presence of sub-clinical left ventricular diastolic dysfunction (LVDD) increases cardiovascular risk, the current ESH/ESC guidelines do not include the presence of this condition in the list of target organ damage or cardiovascular risk charts dedicated to the hypertensive population. Several conditions may predict the LVDD occurrence, however, clustering of these factors with hypertension makes the relationship less clear. Therefore, the aim of this study was to evaluate both the occurrence and the severity of diastolic dysfunction in a large cohort of treated hypertensives. METHODS We retrospectively analyzed records of 610 hypertensive participants of the CARE NORTH Study who consented to echocardiography and were free of overt cardiovascular disease. Mean age was 54.0 ± 13.9 years (mean ± SD), BMI 29.7 ± 4.8 kg/m2. The exclusion criteria were: established heart failure, LVEF <45%, coronary revascularization, valvular defect, atrial fibrillation, or stroke. The staging of LVDD was based on comprehensive transthoracic echocardiographic measurements. RESULTS 49.7% percent of the patients had normal diastolic function (38.8% vs. 59.0%, females (F) vs. males (M), respectively; p < .001). Grade 1 LVDD was documented in 24.4% (27.8% and 21.6%; F and M; p = .08) and grade 2 LVDD in 19.3% (24.9% and 14.6%; F and M; p = .001) of the patients. None were diagnosed with grade 3 LVDD. In the logistic regression model, female sex, advancing age, obesity status, established diabetes mellitus, higher 24-hour SBP, and increasing LVMI were identified as the independent variables increasing the odds for the presence of LVDD, whereas blood-lowering therapy attenuated the risk. CONCLUSIONS There is an unexpectedly high prevalence of different forms of diastolic dysfunction in treated hypertensive patients who are free of overt cardiovascular disease.
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Affiliation(s)
- Ewa Świerblewska
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Jacek Wolf
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Katarzyna Kunicka
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Beata Graff
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Katarzyna Polonis
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Michał Hoffmann
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Marzena Chrostowska
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Anna Szyndler
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Piotr Bandosz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Beata Graff
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdańsk , Gdańsk , Poland
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7
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Vähämurto L, Juonala M, Ruohonen S, Hutri-Kähönen N, Kähönen M, Laitinen T, Tossavainen P, Jokinen E, Viikari J, Raitakari O, Pahkala K. Geographic origin as a determinant of left ventricular mass and diastolic function – the Cardiovascular Risk in Young Finns Study. Scand J Public Health 2018; 46:630-637. [DOI: 10.1177/1403494818764782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aims: Eastern Finns have higher risk of coronary heart disease (CHD) and carotid intima-media thickness than western Finns although current differences in CHD risk factors are minimal. Left ventricular (LV) mass and diastolic function predict future cardiovascular events but their east–west differences are unknown. We examined the association of eastern/western baseline origin with LV mass and diastolic function. Methods : The study population included 2045 subjects of the Cardiovascular Risk in Young Finns Study with data from the baseline survey (1980) and the latest follow-up (2011) when echocardiography was performed at the age of 34–49 years. Results: Subjects with eastern baseline origin had in 2011 higher LV mass (139±1.0 vs. 135±1.0 g, p=0.006) and E/e′-ratio indicating weaker LV diastolic function (4.86±0.03 vs. 4.74±0.03, p=0.02) than western subjects. Results were independent of age, sex, area of examination and CHD risk factors such as blood pressure and BMI (LV mass indexed with height: p<0.0001; E/e′-ratio: p=0.01). LV end-diastolic volume was higher among subjects with eastern baseline origin (135±0.9 vs. 131±0.9 ml, p=0.0011) but left atrial end-systolic volume, also indicating LV diastolic function, was not different between eastern and western subjects (43.4±0.5 vs. 44.0±0.5 ml, p=0.45). Most of the subjects were well within the normal limits of these echocardiographic measurements. Conclusions: In our healthy middle-aged population, geographic origin in eastern Finland associated with higher LV mass compared to western Finland. Higher E/e′-ratio suggests that subjects with eastern baseline origin might have higher prevalence of diastolic dysfunction in the future than western subjects.
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Affiliation(s)
- L. Vähämurto
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - M. Juonala
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - S. Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - N. Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Finland
| | - M. Kähönen
- Department of Clinical Physiology, Tampere University Hospital and University of Tampere, Finland
| | - T. Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
| | | | - E. Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland
| | - J. Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - O.T. Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - K. Pahkala
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
- Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Finland
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8
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Prognostic implications of fasting plasma glucose in subjects with echocardiographic abnormalities. Int J Cardiol 2017; 241:423-429. [DOI: 10.1016/j.ijcard.2017.01.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
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9
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Pareek M, Bhatt DL, Vaduganathan M, Biering-Sørensen T, Qamar A, Diederichsen AC, Møller JE, Hindersson P, Leósdóttir M, Magnusson M, Nilsson PM, Olsen MH. Single and multiple cardiovascular biomarkers in subjects without a previous cardiovascular event. Eur J Prev Cardiol 2017. [PMID: 28644092 DOI: 10.1177/2047487317717065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims To assess the incremental value of biomarkers, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), growth differentiation factor 15 (GDF-15), and procollagen type 1 N-terminal propeptide (P1NP), in predicting incident cardiovascular events and mortality among asymptomatic individuals from the general population, beyond traditional risk factors, including fasting glucose and renal function (cystatin C), medication use, and echocardiographic measures. Methods and results Prospective population-based cohort study of 1324 subjects without a previous cardiovascular event, who underwent baseline echocardiography and biomarker assessment between 2002 and 2006. The clinical endpoint was the composite of myocardial infarction, invasively treated stable/unstable ischemic heart disease, heart failure, stroke, or all-cause mortality. Predictive capabilities were evaluated using Cox proportional-hazards regression, Harrell's concordance index (C-index), and net reclassification improvement. Median age was 66 (interquartile range: 60-70) years, and 413 (31%) were female. During median 8.6 (interquartile range: 8.1-9.2) follow-up years, 368 (28%) composite events occurred. NT-proBNP, hs-TnT, GDF-15, and IL-6 were significantly associated with outcome, independently of traditional risk factors, medications, and echocardiography ( p < 0.05 for all). Separate addition of NT-proBNP and GDF-15 to traditional risk factors, medications, and echocardiographic measurements provided significant improvements in discriminative ability (NT-proBNP: C-index 0.714 vs. 0.703, p = 0.03; GDF-15: C-index 0.721 vs. 0.703, p = 0.02). Both biomarkers remained significant predictors of outcome upon inclusion in the same model ( p < 0.05 for both). Conclusions NT-proBNP and GDF-15 each enhance prognostication beyond traditional risk factors, glucose levels, renal function, and echocardiography in individuals without known cardiovascular disease.
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Affiliation(s)
- Manan Pareek
- 1 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA.,2 Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,3 Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Denmark
| | - Deepak L Bhatt
- 1 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | - Muthiah Vaduganathan
- 1 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | - Tor Biering-Sørensen
- 1 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA.,4 Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Arman Qamar
- 1 Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | | | | | - Peter Hindersson
- 6 Department of Clinical Biochemistry, Regional Hospital of Northern Jutland, Hjørring, Denmark
| | - Margrét Leósdóttir
- 7 Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,8 Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Magnusson
- 7 Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,8 Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- 8 Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Michael H Olsen
- 3 Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Denmark
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Nielsen ML, Pareek M, Gerke O, Leósdóttir M, Nilsson PM, Olsen MH. Greater body mass index is a better predictor of subclinical cardiac damage at long-term follow-up in men than is insulin sensitivity: a prospective, population-based cohort study. BMC Cardiovasc Disord 2015; 15:168. [PMID: 26655187 PMCID: PMC4676144 DOI: 10.1186/s12872-015-0165-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine whether lower insulin sensitivity as determined by homeostatic model assessment (HOMA-%S) was associated with increased left ventricular mass (LVM) and presence of LV diastolic dysfunction at long-term follow-up, independently of body mass index (BMI), in middle-aged, otherwise healthy males. METHODS Prospective population-based cohort study with a median (IQR) follow-up time of 28 (27-28) years, in which traditional cardiovascular risk factors, including HOMA-%S and BMI, were assessed at baseline, and echocardiographic determination of LVM and LV diastolic function was performed at follow-up. Associations between risk factors and echocardiographic variables were tested using multivariable linear and binary logistic regression. RESULTS The study population comprised 247 men with a median (IQR) age of 47 (47-48) years. Mean (SD) BMI was 25.1 +/- 3.0 kg/m(2), and median (IQR) HOMA-%S was 113.0 (68.3-284.6). Subjects with low insulin sensitivity (lowest HOMA-%S quartile (Q1)) had significantly greater BMI, fasting plasma insulin, and higher fasting blood glucose (FBG) (p <0.02 for all). BMI and HOMA-%S were significantly correlated (r = -0.383, p <0.0001). At follow-up, mean (SD) LVM and LVMI were 202 +/- 61 g and 103 +/- 31 g/m(2), respectively, whereas median (IQR) E/é was 10 (8-12). Moreover, 36 % had grade 2 or 3 diastolic dysfunction. In multivariable analyses, greater BMI, but not low insulin sensitivity was independently associated with later detection of increased LVM and diastolic dysfunction. CONCLUSION Greater baseline BMI, but not lower insulin sensitivity was independently associated with greater LVM and diastolic dysfunction at long-term follow-up.
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Affiliation(s)
- Mette Lundgren Nielsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark.
| | - Manan Pareek
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense and Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark.
| | | | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Michael Hecht Olsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark. .,Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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Untreated diabetes mellitus, but not impaired fasting glucose, is associated with increased left ventricular mass and concentric hypertrophy in an elderly, healthy, Swedish population. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ijcme.2015.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pareek M, Nielsen ML, Leósdóttir M, Nilsson PM, Olsen MH. Response to the letter by Tomoyuki Kawada: Diastolic function, fasting plasma glucose and left ventricular mass index. Int J Cardiol 2015; 194:58-9. [PMID: 26011264 DOI: 10.1016/j.ijcard.2015.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Manan Pareek
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark.
| | - Mette Lundgren Nielsen
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
| | | | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Michael Hecht Olsen
- 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
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Kawada T. Diastolic function, fasting plasma glucose and left ventricular mass index. Int J Cardiol 2015; 193:58. [DOI: 10.1016/j.ijcard.2015.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/10/2015] [Indexed: 11/30/2022]
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