Impact of diabetes on cardiac structure and function - The strong heart study

Background-Whether diabetes mellitus (DM) adversely affects left ventricula r (LV) structure and function independently of increases in body mass index (BMI) and blood pressure is controversial. Methods and Results-Echocardiography was used in the Strong Heart Study, a study of cardiovascular disease in American Indians, to compare LV measurem ents between 1810 participants with DM and 944 with normal glucose toleranc e. Participants with DM were older (mean age, 60 versus 59 years), had high er BMI (32.4 versus 28.9 kg/m(2)) and systolic blood pressure (133 versus 1 24 mm Hg), and were more likely to be female, to be on antihypertensive tre atment, and to live in Arizona (all P<0.001). In analyses adjusted for cova riates, women and men with DM had higher LV mass and wall thicknesses and l ower LV fractional shortening, midwall shortening, and stress-corrected mid wall shortening (all P<0.002), Pulse pressure/stroke volume, a measure of a rterial stiffness, was higher in participants with DM (P<0.001 independent of confounders). Conclusions-Non-insulin-dependent DM has independent adverse cardiac effect s, including increased LV mass and wall thicknesses, reduced LV systolic ch amber and myocardial function, and increased arterial stiffness. These find ings identify adverse cardiovascular effects of DM, independent of associat ed increases in BMI and arterial pressure, that may contribute to cardiovas cular events in diabetic individuals.