Separate and joint effects of systemic hypertension and diabetes mellitus on left ventricular structure and function in American Indians - (The strong heart study)

Although the association of systemic hypertension (SH) with diabetes mellit us (DM) is well established, the cardiac features and hemodynamic profile o f patients with SH and DM diagnosed by American Diabetes Association criter ia have not been elucidated. To address this issue, echocardiograms were an alyled in 1,025 American Indian participants of the Strong Heart Study with neither DM nor SH, 642 with DM alone, 614 with SH alone, and 874 with SH a nd DM. In analyses that adjusted for age, gender, body mass index, and hear t rate, DM and SH were associated with increased left ventricular (LV) wall thicknesses, with the greatest impact of DM on LV relative wall thickness and of the combination of DM and SH on LV mass (both p <0.001). LV fraction al shortening was reduced with SH and SH + DM, midwall shortening was reduc ed with DM, SH, and their combination, and was reduced in both diabetic gro ups compared with their nondiabetic counterparts (p <0.001). DM alone was a ssociated with lower measures of LV pump performance (stroke volume, cardia c output, and their indexes) than SH alone. Pulse pressure/stroke index, an indirect measure of arterial stiffness, was elevated in participants with DM or SH alone and most in those with both conditions. There were progressi ve increases from the reference group to DM alone, SH alone, and DM + SH wi th regard to prevalences of IV hypertrophy (12% to 19%, 29% and 38%) and su bnormal LV myocardial function (7% to 10%, 11% and 18%, both p <less than>0 .001). In conclusion, DM and SH each have adverse effects on LV geometry an d function, and the combination of SH and DM results in the greatest degree of LV hypertrophy, myocardial dysfunction, and arterial stiffness. (C) 200 1 by Excerpta Medica, Inc.