Hemodynamic and metabolic factors in the prediction of diastolic dysfunction

Objective: To explore possible hemodynamic and metabolic determinants of diastolic dysfunction in a random population sample. Design and method: We examined associations between hemodynamic factors (systolic blood pressure (SBP), heart rate (HR)), metabolic factors (fasting insulin, fasting plasma glucose, 2-hour glucose during oral glucose tolerance test (OGTT), oral disposition index (DIo), and Homeostatic Model Assessment (HOMA) derived indices of beta-cell function (HOMA-2B), insulin sensitivity (HOMA-2S), and insulin resistance (HOMA-2IR)), other traditional cardiovascular risk factors, and later detection of grade 2 or 3 diastolic dysfunction (DD) in 243 men and 22 women aged 28 to 57 years at the time of inclusion, using binary logistic regression analysis. Study subjects came from a random population based sample and were included 1974-1992, whilst the echocardiography was performed 2002-2006. Results: After a mean follow-up time of 27 years, grade 2 or 3 diastolic dysfunction was detected in 34% (n = 89) of subjects. In univariate analyses (significance level 0.05), diastolic dysfunction was associated with age, sex, heart rate, systolic blood pressure, fasting insulin levels, 2-hour glucose levels, HOMA-2B, HOMA- 2S, HOMA-2IR, and the time elapsed between inclusion and echocardiography. In multivariable analysis (significance level 0.20), sex (odds ratio (OR) = 6.08 (95% confidence interval (CI), 1.26-29.25); p = 0.02), heart rate (OR = 1.02 (95% CI, 0.996-1.05); p = 0.1), HOMA-2B (OR = 1.01 (95% CI, 1.00-1.01); p = 0.051), and time span (OR = 1.84 (95% CI, 1.73-1.96); p = 0.01), remained significantly associated with diastolic dysfunction, whereas age was forced into the model (OR = 1.03 (95% CI, 0.96-1.11); p = 0.41). We did not detect any significant interactions between HOMA-2B and other variables in the prediction of diastolic dysfunction. Conclusions: In a binary logistic regression model adjusted for age, sex, and time, HOMA-2B was significantly associated with the development of grade 2 or 3 diastolic dysfunction. It is suggested that subjects with increased HOMA-2B values may be at greater cardiovascular risk.