Diastolic dysfunction is equally common in pre-diabetes and diabetes and associated with concomitant cardiometabolic...

To investigate the prevalence of diastolic dysfunction and associated risk factors in pre-diabetes and diabetes in the general population.

Diastolic function was assessed by transthoracic echocardiography in a cross-sectional sample of 3840 men and women aged 50-64 years from the Swedish CArdioPulmonary bioImage Study. Anthropometry, medical history, blood pressure, biochemistry and coronary atherosclerosis assessed by CT were recorded. Population-specific reference ranges were applied. Diastolic function was compared across glycaemic groups and analysed in relation to risk factors.

Normoglycaemia was present in 82%, pre-diabetes in 12% and diabetes in 6%. Diastolic function was impaired (p<0.001) in pre-diabetes and diabetes, with higher prevalence of abnormal diastolic variables in pre-diabetes (30%) and diabetes (33%) than in normoglycaemia (21%). Among participants with pre-diabetes/diabetes, diastolic dysfunction was associated with hypertension and more severe coronary atherosclerosis (p<0.001). In multivariable analyses, waist circumference (OR 1.034, 95% CI 1.013 to 1.054) and high Coronary Artery Calcium Score (OR 2.897, 95% CI 1.373 to 6.113) were independently associated with diastolic dysfunction, also after exclusion of subjects with ischaemic heart disease. In those without coronary atherosclerosis and hypertension, systolic blood pressure was the only independent risk factor (OR 1.027, 95% CI 1.002 to 1.053).

Diastolic dysfunction was as common in pre-diabetes as in diabetes and was mainly associated with central adiposity, hypertension and coronary atherosclerosis. In individuals without coronary atherosclerosis or hypertension, systolic blood pressure was still the only independent predictor. These findings challenge the concept of a clinically relevant isolated diabetic cardiomyopathy and highlight the importance of early and comprehensive cardiometabolic risk factor control to prevent heart failure with preserved ejection fraction.