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Sex-Specific Determinants of Left Ventricular Mass in Pre-Diabetic and Type 2 Diabetic Subjects

The Augsburg Diabetes Family Study

¹ Department of Internal Medicine I–Cardiology, Central Hospital of Augsburg, Augsburg, Germany
² GSF–National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
³ Diabetes Centre, Department of Internal Medicine, Innenstadt, University of Munich, Munich, Germany
⁴ Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany

Address correspondence and reprint requests to Bernhard Kuch, MD, I Medizinische Klinik, Klinikum Augsburg, Stenglinstrasse 2, D-86156 Augsburg, Germany. E-mail: bernhard.kuch{at}1med.zk-augsburg-med.de

OBJECTIVE— Obesity and hypertension are regarded as the most important determinants of left ventricular mass in the community. Little is known about sex-specific influences of obesity, hypertension, and other risk factors on left ventricular mass in pre-diabetic or diabetic subjects.

RESEARCH DESIGN AND METHODS— We examined how body composition, blood pressure, and other factors are related to left ventricular structure in elderly subjects (mean age 62 years, 88% of women postmenopausal) with pre-diabetes (impaired fasting glucose or impaired glucose tolerance; n = 112) and diabetes with (n = 181) and without (n = 213) overt cardiovascular disease (CVD).

RESULTS— Neither microalbuminuria nor physical activity was significantly associated with left ventricular mass. In pre-diabetic as well as diabetic subjects with CVD, mainly BMI and fat mass, particularly in women, were correlated with left ventricular mass. In the diabetic group without overt CVD, fat mass was only slightly correlated with left ventricular mass. In the latter group waist-to-hip-ratio, and, only in men, systolic blood pressure, glucose, and A1C were moderately correlated with left ventricular mass. Multiregression analysis over all groups again revealed fat mass as the main determinant of left ventricular mass in women. In women but not men obesity was associated with a significantly increased prevalence of concentric left ventricular hypertrophy.

CONCLUSIONS— In pre-diabetic and diabetic elderly subjects fat mass is the major determinant of left ventricular mass in women but not in men. These results may partly explain sex differences in CVD mortality in obese elderly diabetic subjects and underscore the need for activities focused on weight reduction.

Abbreviations: CVD, cardiovascular disease • FFM, free fat mass • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • WHR, waist-to-hip ratio

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