Fasting glucose and insulin resistance trajectories during young adulthood and mid-life cardiac structure and function

Abstract

Aims: We assessed whether fasting glucose (FG) and insulin resistance (IR) trajectories during young adulthood are associated with changes in cardiac structure and function.

Methods: We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study (baseline: 1985-1986). Echocardiography was performed after 25 (Y25) and 30 years of follow-up. Group-based modeling was used to determine 25-year trajectories in FG and IR. We assessed differences at Y25 and 5-year longitudinal change in cardiac structure and function after adjustment for demographics, cumulative exposure to traditional cardiovascular risk factors, and baseline FG or IR.

Results: We identified five FG trajectory groups among 2414 individuals and three IR trajectory groups among 2358 individuals. Moderate-increasing FG trajectory was associated with lower lateral E' velocity (difference: -0.9 cm/s, 95%CI: -0.3, -1.5) and with greater left ventricular (LV) mass index (difference: 2.7 g/m^2.7, 95%CI: 0.7, 4.7) at Y30 compared to low-stable FG. High-increasing IR trajectory was associated with lower lateral E' velocity and septal E' velocity at Y30 compared to low-decreasing IR trajectory.

Conclusions: Trajectories in FG and IR over 25 years before the development of diabetes are associated with unfavorable differences in LV structure and diastolic function beyond single values of FG and IR.

Keywords: Cardiac structure and function; Epidemiology; Fasting glucose; Insulin resistance; Trajectories.