DIABETES-MELLITUS AND ECHOCARDIOGRAPHIC LEFT-VENTRICULAR FUNCTION IN FREE-LIVING ELDERLY MEN AND WOMEN - THE CARDIOVASCULAR HEALTH STUDY

This report describes the relation among diabetes, blood pressure, and prevalent cardiovascular disease, and echocardiographically measured left ventricular mass and filling (transmitral valve flow) velocities in the Cardiovascular Health Study, a cohort of 5201 men and women gre ater than or equal to 65 years of age. Ventricular septal and left pos terior wall thicknesses were greater in diabetic than in nondiabetic s ubjects, showing a significant linear trend (p = 0.025 for ventricular septal thickness in both sexes combined, p = 0.002 for posterior wall thickness) with increased duration of diabetes. Increased wall thickn ess of the ventricular septum or the left posterior wall was not assoc iated with prevalent coronary heart disease (CHD) in the cohort. Incre ased left ventricular mass was associated with diabetic persons not re porting CHD and with all subjects with CHD regardless of glucose toler ance status. After adjusting for body weight, blood pressure, heart ra te, and prevalent coronary or cerebrovascular disease, diabetes (as me asured by glucose level, insulin use, oral hypoglycemic use, and a pos itive history of diabetes before baseline examination) remained an ind ependent predictor of increased left ventricular mass among men and wo men (174.2 gm in diabetic men vs 169.8 gm in normal men, 138.2 gm in d iabetic women vs 134.0 gm in normal women, p = 0.043 for both sexes co mbined). Both early and late diastolic transmitral peak Row velocities were higher with increased duration of diabetes, but the calculated r atio of the early peak flow velocity to the late velocity (E/A ratio) did not differ significantly between subjects with historical diabetes and those with normal fasting glucose (both genders combined, p = 0.1 90). Glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination were significant inde pendent predictors of the late transmitral peak flow velocity and its integrated Row-velocity curve but not for the integral of the early pe ak Row velocity or the E/A ratio. Diabetes is associated with abnormal left ventricular structure and function in elderly persons. This asso ciation persists after adjustment for body weight, blood pressure, hea rt rate, and reported coronary or cerebrovascular disease.