Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, 90033, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
Cardiovasc Diabetol. 2022 Jun 20;21(1):112. doi: 10.1186/s12933-022-01547-z.
We evaluated whether measures of glucose dysregulation are associated with subclinical cardiac dysfunction, as assessed by speckle-tracking echocardiography, in an older population.
Participants were men and women in the Cardiovascular Health Study, age 65+ years and without coronary heart disease, atrial fibrillation, or heart failure at baseline. We evaluated fasting insulin resistance (IR) with the homeostatic model of insulin resistance (HOMA-IR) and estimated the Matsuda insulin sensitivity index (ISI) and insulin secretion with an oral glucose tolerance test. Systolic and diastolic cardiac mechanics were measured with speckle-tracking analysis of echocardiograms. Multi-variable adjusted linear regression models were used to investigate associations of insulin measures and cardiac mechanics.
Mean age for the 2433 included participants was 72.0 years, 33.6% were male, and 3.7% were black. After adjustment for age, sex, race, site, speckle-tracking analyst, echo image and quality score, higher HOMA-IR, lower Matsuda ISI, and higher insulin secretion were each associated with worse left ventricular (LV) longitudinal strain and LV early diastolic strain rate (p-value < 0.005); however, associations were significantly attenuated after adjustment for waist circumference, with the exception of Matsuda ISI and LV longitudinal strain (increase in strain per standard deviation increment in Matsuda ISI = 0.18; 95% confidence interval = 0.03-0.33).
In this cross-sectional study of older adults, associations of glucose dysregulation with subclinical cardiac dysfunction were largely attenuated after adjusting for central adiposity.
我们评估了葡萄糖调节异常的指标是否与亚临床心脏功能障碍相关，亚临床心脏功能障碍通过斑点追踪超声心动图评估，研究对象为心血管健康研究中的老年人，年龄在 65 岁及以上，基线时无冠心病、心房颤动或心力衰竭。我们用稳态模型胰岛素抵抗（HOMA-IR）评估空腹胰岛素抵抗（IR），用口服葡萄糖耐量试验评估胰岛素敏化指数（ISI）和胰岛素分泌。用超声心动图的斑点追踪分析评估心脏收缩和舒张力学。多变量调整线性回归模型用于研究胰岛素指标与心脏力学的关系。
纳入的 2433 名参与者的平均年龄为 72.0 岁，33.6%为男性，3.7%为黑人。在调整年龄、性别、种族、地点、斑点追踪分析员、超声图像和质量评分后，HOMA-IR 较高、Matsuda ISI 较低和胰岛素分泌较高与左心室（LV）纵向应变和 LV 早期舒张应变率较差相关（p 值均<0.005）；然而，在调整腰围后，这些相关性明显减弱，Matsuda ISI 和 LV 纵向应变除外（Matsuda ISI 每标准偏差增加，应变增加 0.18；95%置信区间 0.03-0.33）。
在这项针对老年人的横断面研究中，葡萄糖调节异常与亚临床心脏功能障碍的相关性在调整中心性肥胖后大大减弱。
