Miscellaneous
Jian L. Yeo, MB
Clinical research fellow
University of Leicester, United Kingdom
Jian L. Yeo, MB
Clinical research fellow
University of Leicester, United Kingdom
Pranav Ramesh
Medical student
University of Leicester, United Kingdom
Gaurav S. Gulsin, PhD
Academic clinical lecturer
University of Leicester
Leicester, England, United Kingdom
Abhishek Dattani, MBBS
Clinical Research Fellow
University of Leicester, United Kingdom
Anna-Marie Marsh, PhD
Chief cardiac physiologist
University of Leicester
Leicester, England, United Kingdom
Manjit Sian, BSc
Chief cardiac physiologist
University of Leicester, United Kingdom
Emer M. Brady, PhD
Post-doctoral research fellow
University of Leicester
Leicester, England, United Kingdom
Gerry P. McCann, MD
NIHR research professor
University of Leicester
Leicester, England, United Kingdom
Early onset type 2 diabetes (T2D) is increasingly prevalent, associated with greater cardiovascular risk factors and may portend worse outcomes. We aimed to determine if T2D diagnosed at a younger age is associated with greater left ventricular (LV) remodelling and dysfunction in a cohort of asymptomatic adults without cardiovascular disease.
Methods:
We prospectively enrolled a multi-ethnic cohort of people with T2D and no history of cardiovascular disease. Participants underwent echocardiography and stress perfusion cardiac MRI. Assessments of LV remodelling, defined as LV mass-to-volume ratio (LVM/V ≥ 0.9), systolic (global longitudinal strain, GLS < 16%) and diastolic impairment (E/e’ ≥ 11), and microvascular dysfunction (myocardial perfusion reserve, MPR < 2.5) were performed. Multinomial logistic regression was used to determine the association between age of T2D onset, clustered into those diagnosed at ≤ 40, between 41 and 59, and ≥ 60 years with abnormal LV structure and function, adjusting for sex, ethnicity, smoking, BMI, systolic blood pressure, HbA1c, and duration of T2D.
Results:
We included 467 individuals with T2D (mean age 57±11y, 60% male, 70% white). People diagnosed at an earlier age had higher BMI and HbA1c (p< 0.001 for trend). Those diagnosed at ≤ 40 years of age had higher odds of LV remodelling (OR 3.1, 95% CI 1.5 - 6.5), diastolic impairment (OR 3.9, 1.2 – 12.8), and microvascular dysfunction (OR 3.0, 1.3 - 6.6), but lower odds of systolic dysfunction (OR 0.5, 0.2 – 0.9), compared to those diagnosed at ≥ 60 years. People diagnosed with T2D between 41 to 59 years had higher odds of LV remodelling (OR 2.4, 1.4 – 4.3) and microvascular dysfunction (OR 2.1, 1.1 – 4.0) only.
Conclusion:
Diagnosis of T2D at ≤ 40 years is associated with a 3-to-4-fold higher odds of concentric LV remodelling, diastolic impairment, and coronary microvascular dysfunction compared to people diagnosed ≥ 60 years. Aggressive risk factor management should be considered to prevent or delay progression of cardiac maladaptation in younger people with T2D.