Duration of Prediabetes, Diabetes Independently Associated With Subclinical Atherosclerosis, Cardiac Dysfunction

A longer duration of prediabetes and diabetes in adults may be associated independently with the development of subclinical atherosclerosis and left ventricular systolic and diastolic dysfunction measurement later in life, according to a study published in Diabetes Care.

Researchers obtained data at baseline, and at 2, 5, 7, 10, 15, 20, 25, and 30 years on 3628 white and black (47.3%) men and women (56.5%) ages 18 to 30 years who were participating in the CARDIA (Coronary Artery Risk Development in Young Adults; Clinical Trials.gov identifier: NCT00005130) population-based cohort study. 

The goal was to determine whether the accumulation of time over 25 years beginning in early adulthood is independently associated with the development of subclinical atherosclerosis and/or changes in cardiac structure and function later in life.

Study results found adults in whom diabetes and prediabetes (12.7 and 53.8%, respectively) developed experienced an average (standard deviation) duration of 10.7 (5.6) and 9.5 (5.2) years, respectively. It was noted in this study that individuals who had diabetes and prediabetes for a longer time had higher fasting 2-hour glucose, hemoglobin A_1c, and insulin levels during the follow-up period. Further, black individuals with a family history of diabetes, lower educational level, and worse cardiovascular disease risk factors were more likely to have had diabetes and prediabetes for a longer time.

Hazard ratios for coronary artery calcified plaque development with each 5-year increment of diabetes and prediabetes duration was found to be 1.15 (95% CI, 1.06-1.25) and 1.07 (95% CI, 1.01-1.13), respectively. Interestingly, those who did not have diabetes compared with those who had diabetes were found to have a hazard ratio of 1.57 (95% CI, 1.18, 2.08).

Worse left ventricular relaxation and greater left ventricular filling pressures (e’ [P_trend <.001)] were found in individuals who had diabetes and prediabetes for a longer period (e’ [P_trend <.001 and E-to-e’ ratio [P_trend <.001), and had low ejection fraction (P_trend .57 and .13) and worse longitudinal strain (P_trend <.001 and <.001).

Researchers concluded that an independent association between having diabetes for a longer time and having prediabetes in early childhood is associated with subclinical atherosclerosis and measurement of left ventricular systolic and diastolic dysfunction later in life. Therefore, clinicians should identify individuals at high risk for diabetes or prediabetes, and should be aware of these risks to discourage behaviors known to cause diabetes as well as work with individuals to lose weight and obtain optimal glucose control.   

Reference

Reis JP, Allen NB, Bancks MP, et al. Duration of diabetes and prediabetes during adulthood and subclinical atherosclerosis and cardiac dysfunction in middle age: the CARDIA study [published online January 9, 2018]. Diabetes Care. doi: 10.2337/dc17-2233