Palmieri V, Bella J N, Arnett D K, Liu J E, Oberman A, Schuck M Y, Kitzman D W, Hopkins P N, Morgan D, Rao D C, Devereux R B
Weill Medical College of Cornell University, New York, NY 10021, USA.
Circulation. 2001 Jan 2;103(1):102-7. doi: 10.1161/01.cir.103.1.102.
Type 2 diabetes is a cardiovascular risk factor. It remains to be elucidated in a large, population-based sample whether diabetes is associated with changes in left ventricular (LV) structure and systolic function independent of obesity and systolic blood pressure (BP).
Among 1950 hypertensive participants in the HyperGEN Study without overt coronary heart disease or significant valve disease, 20% (n=386) had diabetes. Diabetics were more likely to be women, black, older, and have higher BMI and waist/hip ratio than were nondiabetics. After adjustment for age and sex, diabetics had higher systolic BP, pulse pressure, and heart rate; lower diastolic BP; and longer duration of hypertension than nondiabetics. LV mass and relative wall thickness were higher in diabetic than nondiabetic subjects independent of covariates. Compared with nondiabetic hypertensives, diabetics had lower stress-corrected midwall shortening, independent of covariates, without difference in LV EF. Insulin levels and insulin resistance were higher in non-insulin-treated diabetics (n=195) than nondiabetic (n=1439) subjects (both P:<0.01). Insulin resistance positively but weakly related to LV mass and relative wall thickness.
In a relatively healthy, population-based sample of hypertensive adults, type 2 diabetes was associated with higher LV mass, more concentric LV geometry, and lower myocardial function, independent of age, sex, body size, and arterial BP. structural and functional abnormalities in addition to, and independent of, atherosclerosis.(13) (14) In the Framingham cohort, diabetes was associated with higher LV mass in women but not men.(15) High blood pressure (BP), obesity, and abnormal lipid profile, which often coexist with diabetes, tend to be associated with preclinical cardiovascular abnormalities(16) and may contribute to the association of diabetes with cardiovascular events. Cardiac features of diabetic and nondiabetic hypertensive subjects remain incompletely described in population-based samples. Therefore, we compared clinical and metabolic characteristics, LV geometry, and systolic function between diabetic and nondiabetic hypertensive participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study.
2型糖尿病是一种心血管危险因素。在一个基于人群的大样本中，糖尿病是否与独立于肥胖和收缩压（BP）的左心室（LV）结构及收缩功能变化相关，仍有待阐明。
在高血压遗传流行病学网络（HyperGEN）研究中，1950名无明显冠心病或严重瓣膜病的高血压参与者中，20%（n = 386）患有糖尿病。与非糖尿病患者相比，糖尿病患者更可能为女性、黑人、年龄较大，且体重指数（BMI）和腰臀比更高。在调整年龄和性别后，糖尿病患者的收缩压、脉压和心率更高；舒张压更低；高血压病程比非糖尿病患者更长。独立于协变量，糖尿病患者的左心室质量和相对室壁厚度高于非糖尿病患者。与非糖尿病高血压患者相比，糖尿病患者的应激校正后室壁中层缩短率更低，独立于协变量，左心室射血分数（LV EF）无差异。未接受胰岛素治疗的糖尿病患者（n = 195）的胰岛素水平和胰岛素抵抗高于非糖尿病患者（n = 1439）（P均<0.01）。胰岛素抵抗与左心室质量和相对室壁厚度呈正相关但较弱。
在一个相对健康的、基于人群的高血压成年样本中，2型糖尿病与更高的左心室质量、更向心性的左心室几何形态和更低的心肌功能相关，独立于年龄、性别、体型和动脉血压。除动脉粥样硬化外，还存在独立于动脉粥样硬化的结构和功能异常。（13）（14）在弗雷明汉队列研究中，糖尿病与女性而非男性的左心室质量增加有关。（15）经常与糖尿病并存的高血压、肥胖和血脂异常往往与临床前心血管异常相关（16），可能导致糖尿病与心血管事件之间的关联。在基于人群的样本中，糖尿病和非糖尿病高血压患者的心脏特征仍未完全描述清楚。因此，我们在高血压遗传流行病学网络（HyperGEN）研究中比较了糖尿病和非糖尿病高血压参与者的临床和代谢特征、左心室几何形态和收缩功能。
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