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Diabetic Cardiomyopathy and Subclinical Cardiovascular Disease

The Multi-Ethnic Study of Atherosclerosis (MESA)

¹ Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
² Department of Preventive Medicine, Northwestern University, Chicago, Illinois
³ Department of Medicine, Johns Hopkins University, Baltimore, Maryland
⁴ Department of Radiology, Tufts-New England Medical Center, Boston, Massachusetts
⁵ Department of Preventive Medicine, Health Sciences Center School of Medicine, Stony Brook, New York
⁶ Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
⁷ Department of Pathology, University of Vermont, Colchester, Vermont
⁸ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Dr. Alain G. Bertoni, Wake Forest University Health Sciences, Department of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157. E-mail: abertoni{at}wfubmc.edu

OBJECTIVE—Studies have demonstrated increased left ventricular mass (LVM) and diastolic dysfunction among diabetic patients without clinical cardiovascular disease (CVD), but few have assessed the potential contribution of subclinical CVD to ventricular abnormalities in diabetes. We examined whether diabetic cardiomyopathy is associated with subclinical atherosclerosis and if abnormalities are found with impaired fasting glucose (IFG).

RESEARCH DESIGN AND METHODS—LVM, end-diastolic volume (EDV), and stroke volume were measured by magnetic resonance imaging (MRI), and atherosclerosis was assessed by coronary artery calcium and carotid intima-media wall thickness in 4,991 participants in the Multi-Ethnic Study of Atherosclerosis, a cohort study of adults aged 45–84 without prior CVD. Multivariable linear regression was used to analyze the association between MRI measures and glucose status.

RESULTS—Increased LVM was observed in white, black, and Hispanic participants with diabetes but not among Chinese participants. After adjustment for weight, height, CVD risk factors, and subclinical atherosclerosis, ethnicity-specific differences in ventricular parameters were present. Among whites and Chinese with diabetes, LVM was similar to that in normal subjects; EDV and stroke volume were reduced. In blacks with diabetes, EDV and stroke volume were reduced, and LVM was increased (+5.6 g, P < 0.05). Among Hispanics with diabetes, EDV and stroke volume were similar to normal, but LVM was increased (+5.5 g, P < 0.05). After adjustment, IFG was associated with a decrease in EDV and stroke volume in whites and blacks only; however, no significant differences in LVM were observed.

CONCLUSIONS—Ethnicity-specific differences in LVM, EDV, and stroke volume are associated with abnormal glucose metabolism and are independent of subclinical CVD.

Abbreviations: CAC, coronary artery calcium • CVD, cardiovascular disease • EDV, end-diastolic volume • ESV, end-systolic volume • IFG, impaired fasting glucose • IMT, intima-media thickness • LVM, left ventricular mass • MESA, Multi-Ethnic Study of Atherosclerosis • MRI, magnetic resonance imaging • NFG, normal fasting glucose

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