Prognostic implications of fasting plasma glucose in subjects with echocardiographic abnormalities
A new article in International Journal of Cardiology (February 2017) by Danish Diabetes Academy fellow, Manan Pareek, University of Southern Denmark and Harvard Medical School, who recently completed his PhD, shows that echocardiographic abnormalities were more strongly associated with an adverse prognosis among subjects with impaired fasting glucose or diabetes. Furthermore, the risk of future cardiovascular events was particularly high in subjects who had both abnormal changes on cardiac ultrasound and elevated fasting glucose.
FASTING GLUCOSE AND SUBCLINICAL CARDIOVASCULAR DISEASE
"We have previously found an increased prevalence of echocardiographic left ventricular hypertrophy, concentric changes, and diastolic dysfunction in subjects with hyperglycemia, particularly among patients with diabetes. Left ventricular hypertrophy and diastolic dysfunction are independent predictors of cardiovascular morbidity and mortality in subjects both with and without diabetes, but whether the prognostic impact of early echocardiographic abnormalities varies by glycemic status is not known", states Manan Pareek.
FASTING GLUCOSE AND INCIDENT CARDIOVASCULAR EVENTS
Manan Pareek's study demonstrated that fasting plasma glucose, particularly diabetes, and the presence of structural and functional echocardiographic alterations were independently associated with an increased cardiovascular risk. The adverse risk related to echocardiographic abnormalities was modified by fasting glycemic status, particularly in older individuals, without known cardiovascular disease, who did not receive cardiovascular, anti-diabetic, or lipid-lowering medication.
CLINICAL PERSPECTIVES
According to Manan Pareek, adverse left ventricular remodeling may be a key mechanistic link between diabetes and overall cardiovascular risk, and the complex intersection between diabetes, left ventricular remodeling, and cardiovascular risk requires further study. It is possible that blood biomarkers primarily reflect subclinical cardiac damage in this population. Future global cardiovascular prevention efforts should focus on halting the progression and attenuating the prognostic impact of adverse left ventricular alterations in diabetes.
SUMMARY
The risk of future cardiovascular events was particularly high in subjects who had both abnormal changes on cardiac ultrasound and elevated fasting glucose.
AUTHORS AND AFFILIATIONS
Manan Pareek1,2; Muthiah Vaduganathan2; Deepak L. Bhatt2; Margrét Leósdóttir3; Michael H. Olsen1,4
1Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Sdr. Boulevard 29, Odense University Hospital, 5000 Odense C, Denmark
2Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
3Department of Cardiology, Skåne University Hospital, Södra Förstadsgatan 101, 205 02 Malmö, Sweden
4Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark