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VOLUME 12 NUMBER 2 • NOVEMBER 2015
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
In 884 children and adolescents with a high prevalence of obesity,
Di Bonito
et al
. found that higher triglyceride-to-HDL cholesterol ratio
independently predicted higher RWT and concentric LV hypertrophy.
28
In our study, lower serum HDL cholesterol levels, but not triglyceride-
to-HDL cholesterol ratio, were associated with higher RWT in type 2
diabetes patients, only in univariate analysis. The differential findings
probably reflect differences in prevalence of obesity and degree of
myocardial fat storage between the two populations.
29
In the LIFE study, concentric remodelling was associated with a
three and eight times increased risk of stroke and cardiovascular
death after 4.8 years of follow up, respectively.
30
So, in a way,
our findings may be explaining the link between the increased
prevalence of congestive heart failure and stroke seen among black
diabetic patients.
31
Of note, an independent association between gender and
measures of LV geometry was not found in the present study
population, partly contrasting with findings in African Americans
participating in the Atherosclerosis Risk in Community (ARIC)
study, which reported that diabetic women had more concentric LV
geometry, but similar prevalence of LV hypertrophy as men.
32
We have shown that a simple algorithm using every-day clinical
and laboratory tests (type of diabetes, hypertension, obesity and
albuminuria) may be used to identify three out of four high-risk
diabetic patients with increased RWT. This is very important in a
setting such as Tanzania where echocardiography is not readily
available. Of note, following this algorithm, a patient with type 2
diabetes with any of the other three risk factors, or a type 1 diabetes
patient having any two of the other three risk factors will have a
76% chance of having cardiac target-organ damage as well.
Conclusion
We have shown that abnormal LV geometry was common in this
diabetic population. In particular, increased RWT was present
in 58% of patients and demonstrated as a marker of subclinical
cardiac target-organ damage. Furthermore, using the clinical risk
factors, type of diabetes, hypertension, obesity and albuminuria,
76% of diabetic patients with increased RWT can be identified.
References
1. Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A. New
type of cardiomyopathy associated with diabetic glomerulosclerosis.
Am J Cardiol
1972;
30
: 595–602.
2. Hamby RI, Zoneraich S, Sherman L. Diabetic cardiomyopathy.
J Am Med Assoc
1974;
229
: 1749–1754.
3. Devereux RB, Roman MJ, Paranicas M, O’Grady MJ, Lee ET, Welty TK,
et al
. Impact
of diabetes on cardiac structure and function: the strong heart study.
Circulation
2000;
101
: 2271–2276.
4. Kizer JR, Arnett DK, Bella JN, Paranicas M, Rao DC, Province MA,
et al
. Differences
in left ventricular structure between black and white hypertensive adults: the
Hypertension Genetic Epidemiology Network study.
Hypertension
2004;
43
:
1182–1188.
5. Drazner MH, Dries DL, Peshock RM, Cooper RS, Klassen C, Kazi F,
et al
. Left
ventricular hypertrophy is more prevalent in blacks than whites in the general
population: the Dallas Heart Study.
Hypertension
2005;
46
: 124–129.
6. Yancy CW. Heart failure in African Americans.
Am J Cardiol
2005;
96
: 3i–12i.
7. Swai AB, McLarty DG, Kitange HM, Kilima PM, Tatalla S, Keen N,
et al
. Low
prevalence of risk factors for coronary heart disease in rural Tanzania.
Int J
Epidemiol
1993;
22
: 651–659.
8. Van der Sande MA. Cardiovascular disease in sub-Saharan Africa: a disaster
waiting to happen.
Neth J Med
2003;
61
: 32–36.
9. Rayner B, Becker P. The prevalence of microalbuminuria and ECG left ventricular
hypertrophy in hypertensive patients in private practices in South Africa.
Cardiovasc J S Afr
2006;
17
: 245–249.
10. Lutale JJ, Thordarson H, Abbas ZG, Vetvik K. Microalbuminuria among type 1 and
type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania.
BMC nephrol
2007;
8
: 2.
11. Lutale JJ, Thordarson H, Gulam-Abbas Z, Vetvik K, Gerdts E. Prevalence and
covariates of electrocardiographic left ventricular hypertrophy in diabetic patients
in Tanzania.
Cardiovasc J Afr
2008;
19
: 8–14.
12. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G,
et
al
. 2007 Guidelines for the Management of Arterial Hypertension: The Task
Force for the Management of Arterial Hypertension of the European Society of
Hypertension (ESH) and of the European Society of Cardiology (ESC).
J Hypertens
2007;
25
: 1105–1187.
13. Jensen JS, Clausen P, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Detecting
microalbuminuria by urinary albumin/creatinine concentration ratio.
Nephrol Dial
Transplant
1997;
12
: 6–9.
14. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA,
et al
.
Recommendations for chamber quantification.
Eur J Echocardiogr
2006;
7
:
79–108.
15. Palmieri V, Dahlof B, DeQuattro V, Sharpe N, Bella JN, de Simone G,
et al
. Reliability
of echocardiographic assessment of left ventricular structure and function:
the PRESERVE study. Prospective Randomized Study Evaluating Regression of
Ventricular Enlargement.
J Am Coll Cardiol
1999;
34
: 1625–1632.
16. Gaasch WH, Zile MR, Hoshino PK, Apstein CS, Blaustein AS. Stressshortening
relations and myocardial blood flow in compensated and failing canine hearts
with pressure-overload hypertrophy.
Circulation
1989;
79
: 872–883.
17. De Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH,
et
al
. Assessment of left ventricular function by the midwall fractional shortening/
end-systolic stress relation in human hypertension.
J Am Coll Cardiol
1994;
23
:
1444–1451.
18. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue
imaging: a noninvasive technique for evaluation of left ventricular relaxation and
estimation of filling pressures.
J Am Coll Cardiol
1997;
30
: 1527–1533.
19. Bella JN, Devereux RB, Roman MJ, Palmieri V, Liu JE, Paranicas M,
et al
. Separate
and joint effects of systemic hypertension and diabetes mellitus on left ventricular
structure and function in American Indians (the Strong Heart Study).
Am J Cardiol
2001;
87
: 1260–1265.
20. Palmieri V, Bella JN, Arnett DK, Liu JE, Oberman A, Schuck MY,
et al
. Effect of
type 2 diabetes mellitus on left ventricular geometry and systolic function in
hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN)
study.
Circulation
2001;
103
: 102–107.
21. Ojji DB, Adebiyi AA, Oladapo OO, Adeleye JA, Aje A, Ogah OS,
et al
. Left
ventricular geometric patterns in normotensive type 2 diabetic patients in Nigeria:
an echocardiographic study.
Prev Cardiol
2009;
12
: 184–188.
22. Roman MJ, Ganau A, Saba PS, Pini R, Pickering TG, Devereux RB. Impact of
arterial stiffening on left ventricular structure.
Hypertension
2000;
36
: 489–494.
23. Ganau A, Saba PS, Roman MJ, de Simone G, Realdi G, Devereux RB. Ageing
induces left ventricular concentric remodelling in normotensive subjects.
J
Hypertens
1995;
13
: 1818–1822.
24. Gerdts E, Roman MJ, Palmieri V, Wachtell K, Smith G, Nieminen MS,
et al
.
Impact of age on left ventricular hypertrophy regression during antihypertensive
treatment with losartan or atenolol (the LIFE study).
J Hum Hypertens
2004;
18
:
417–422.
25. Eguchi K, Kario K, Hoshide S, Ishikawa J, Morinari M, Shimada K. Type 2 diabetes
is associated with left ventricular concentric remodeling in hypertensive patients.
Am J Hypertens
2005;
18
: 23–29.
26. Sato A, Tarnow L, Parving HH. Prevalence of left ventricular hypertrophy in Type I
diabetic patients with diabetic nephropathy.
Diabetologia
1999;
42
: 76–80.
27. Viberti G, Mogensen CE, Groop LC, Pauls JF. Effect of captopril on progression
to clinical proteinuria in patients with insulin-dependent diabetes mellitus and
microalbuminuria. European Microalbuminuria Captopril Study Group.
J Am Med
Assoc
1994;
271
: 275–279.
28. Di Bonito P, Moio N, Scilla C, Cavuto L, Sibilio G, Sanguigno E,
et al
. Usefulness
of the high triglyceride-to-HDL cholesterol ratio to identify cardiometabolic risk
factors and preclinical signs of organ damage in outpatient children.
Diabetes
Care
2012;
35
: 158–162.
29. Kankaanpaa M, Lehto HR, Parkka JP, Komu M, Viljanen A, Ferrannini E,
et al
.
Myocardial triglyceride content and epicardial fat mass in human obesity:
relationship to left ventricular function and serum free fatty acid levels.
J Clin
Endocrinol Metab
2006;
91
: 4689–4695.
30. Gerdts E, Cramariuc D, de Simone G, Wachtell K, Dahlof B, Devereux RB. Impact
of left ventricular geometry on prognosis in hypertensive patients with left
ventricular hypertrophy (the LIFE study). Eur J Echocardiogr 2008; 9: 809–815.
31. Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan
Africa.
Lancet
2010;
375
: 2254–2266.
32. Foppa M, Duncan BB, Arnett DK, Benjamin EJ, Liebson PR, Manolio TA,
et al
.
Diabetes, gender, and left ventricular structure in African- Americans: the
atherosclerosis risk in communities study.
Cardiovasc Ultrasound
2006;
4
:43.