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Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus

BACKGROUND: Type 2 diabetes mellitus is closely associated with metabolic risk factors that all contribute to impairment of the left ventricle. The implications of having type 2 diabetes mellitus with well‐controlled metabolic risk factors compared to an increasing burden of uncontrolled metabolic r...

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Autores principales: Jørgensen, Peter Godsk, Jensen, Magnus Thorsten, Biering‐Sørensen, Tor, Mogelvang, Rasmus, Fritz‐Hansen, Thomas, Vilsbøll, Tina, Rossing, Peter, Jensen, Jan Skov
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404901/
https://www.ncbi.nlm.nih.gov/pubmed/30371320
http://dx.doi.org/10.1161/JAHA.118.008856
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author Jørgensen, Peter Godsk
Jensen, Magnus Thorsten
Biering‐Sørensen, Tor
Mogelvang, Rasmus
Fritz‐Hansen, Thomas
Vilsbøll, Tina
Rossing, Peter
Jensen, Jan Skov
author_facet Jørgensen, Peter Godsk
Jensen, Magnus Thorsten
Biering‐Sørensen, Tor
Mogelvang, Rasmus
Fritz‐Hansen, Thomas
Vilsbøll, Tina
Rossing, Peter
Jensen, Jan Skov
author_sort Jørgensen, Peter Godsk
collection PubMed
description BACKGROUND: Type 2 diabetes mellitus is closely associated with metabolic risk factors that all contribute to impairment of the left ventricle. The implications of having type 2 diabetes mellitus with well‐controlled metabolic risk factors compared to an increasing burden of uncontrolled metabolic risk factors on left ventricular structure and function are not known. METHODS AND RESULTS: We compared patients with type 2 diabetes mellitus (n=751) with different degrees of uncontrolled metabolic risk factors present with a control group of individuals without present uncontrolled metabolic risk factors as recommended by the World Health Organization (n=80). In patients with well‐controlled metabolic risk factors, only diastolic but neither structural nor systolic measures were impaired compared to the control group: the (early diastolic mitral inflow velocity)/(atrial diastolic mitral inflow velocity) ratio (median 0.94 [interquartile range 0.80, 1.08] versus 1.11 [0.85, 1.38], P<0.001), lateral early diastolic myocardial velocity at the level of the mitral annulus (mean 9.6 m/s [SD 2.5] versus 10.8 [3.5], P<0.001) and lateral (early diastolic mitral inflow velocity)/(early diastolic myocardial velocity at the level of the mitral annulus) (7.7 [6.5, 10.2] versus 6.3 [4.9, 7.8], P<0.001). With an increasing burden of uncontrolled metabolic risk factors, there were increased left ventricular mass index and wall thicknesses and impaired systolic function measured as global longitudinal strain: control group −15.9 (2.0); 0 uncontrolled risk factors −15.3 (2.4); 1 to 2 −14.6 (2.8); and ≥3 −14.0 (2.8), P<0.001. Within the diabetes mellitus group, there were uni‐ and multivariable associations of left ventricular measures and systolic blood pressure, body mass index, hemoglobin A(1c), and HDL‐cholesterol. CONCLUSIONS: In patients with type 2 diabetes mellitus, having well‐controlled metabolic risk factors was associated with only left ventricular diastolic impairment but not with either structural or even subtle measures of systolic function. Increasing burden of uncontrolled metabolic risk factors was associated with structural and functional impairments.
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spelling pubmed-64049012019-03-19 Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus Jørgensen, Peter Godsk Jensen, Magnus Thorsten Biering‐Sørensen, Tor Mogelvang, Rasmus Fritz‐Hansen, Thomas Vilsbøll, Tina Rossing, Peter Jensen, Jan Skov J Am Heart Assoc Original Research BACKGROUND: Type 2 diabetes mellitus is closely associated with metabolic risk factors that all contribute to impairment of the left ventricle. The implications of having type 2 diabetes mellitus with well‐controlled metabolic risk factors compared to an increasing burden of uncontrolled metabolic risk factors on left ventricular structure and function are not known. METHODS AND RESULTS: We compared patients with type 2 diabetes mellitus (n=751) with different degrees of uncontrolled metabolic risk factors present with a control group of individuals without present uncontrolled metabolic risk factors as recommended by the World Health Organization (n=80). In patients with well‐controlled metabolic risk factors, only diastolic but neither structural nor systolic measures were impaired compared to the control group: the (early diastolic mitral inflow velocity)/(atrial diastolic mitral inflow velocity) ratio (median 0.94 [interquartile range 0.80, 1.08] versus 1.11 [0.85, 1.38], P<0.001), lateral early diastolic myocardial velocity at the level of the mitral annulus (mean 9.6 m/s [SD 2.5] versus 10.8 [3.5], P<0.001) and lateral (early diastolic mitral inflow velocity)/(early diastolic myocardial velocity at the level of the mitral annulus) (7.7 [6.5, 10.2] versus 6.3 [4.9, 7.8], P<0.001). With an increasing burden of uncontrolled metabolic risk factors, there were increased left ventricular mass index and wall thicknesses and impaired systolic function measured as global longitudinal strain: control group −15.9 (2.0); 0 uncontrolled risk factors −15.3 (2.4); 1 to 2 −14.6 (2.8); and ≥3 −14.0 (2.8), P<0.001. Within the diabetes mellitus group, there were uni‐ and multivariable associations of left ventricular measures and systolic blood pressure, body mass index, hemoglobin A(1c), and HDL‐cholesterol. CONCLUSIONS: In patients with type 2 diabetes mellitus, having well‐controlled metabolic risk factors was associated with only left ventricular diastolic impairment but not with either structural or even subtle measures of systolic function. Increasing burden of uncontrolled metabolic risk factors was associated with structural and functional impairments. John Wiley and Sons Inc. 2018-09-29 /pmc/articles/PMC6404901/ /pubmed/30371320 http://dx.doi.org/10.1161/JAHA.118.008856 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Jørgensen, Peter Godsk
Jensen, Magnus Thorsten
Biering‐Sørensen, Tor
Mogelvang, Rasmus
Fritz‐Hansen, Thomas
Vilsbøll, Tina
Rossing, Peter
Jensen, Jan Skov
Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title_full Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title_fullStr Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title_full_unstemmed Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title_short Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
title_sort burden of uncontrolled metabolic risk factors and left ventricular structure and function in patients with type 2 diabetes mellitus
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404901/
https://www.ncbi.nlm.nih.gov/pubmed/30371320
http://dx.doi.org/10.1161/JAHA.118.008856
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