Independent Associations of Glucose Status and Arterial Stiffness With Left Ventricular Diastolic Dysfunction: An 8-year follow-up of the Hoorn Study


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Abstract

OBJECTIVETo investigate relative contributions of glucose status and arterial stiffness to markers of left ventricular (LV) systolic and diastolic dysfunction after 8 years of follow-up.RESEARCH DESIGN AND METHODSIn the population-based prospective Hoorn Study, 394 individuals with preserved LV systolic and diastolic function participated, of whom 87 had impaired glucose metabolism and 128 had type 2 diabetes. Measurements including arterial ultrasound and echocardiography were performed according to standardized protocols.RESULTSThe presence of type 2 diabetes was associated with more severe LV systolic and diastolic dysfunction 8 years later: LV ejection fraction was 2.98% (95% CI 0.46–5.51) lower, and left atrial (LA) volume index, LV mass index, and tissue Doppler-derived E/e′ were 3.71 mL/m2 (1.20–6.22), 5.86 g/m2.7 (2.94–8.78), and 1.64 units (0.95–2.33) higher, respectively. Furthermore, presence of impaired glucose metabolism or type 2 diabetes was associated with 8-year increases in LV mass index. More arterial stiffness (measured as a lower distensibility) was associated with LV diastolic dysfunction 8 years later: LA volume index, LV mass index, and E/e′ at follow-up were higher. Subsequent adjustments for baseline mean arterial pressure and/or LV diastolic dysfunction did not eliminate these associations. Associations of type 2 diabetes and arterial stiffness with markers of LV diastolic dysfunction were largely independent of each other.CONCLUSIONSBoth glucose status and arterial distensibility are independently associated with more severe LV diastolic dysfunction 8 years later and with deterioration of LV diastolic dysfunction. Therefore, type 2 diabetes and arterial stiffness may relate to LV diastolic dysfunction through different pathways.

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