Cardiac structure and function across the continuum of glucose metabolism

PMCID: PMC12172345

PMID: 40526029

DOI: 10.14814/phy2.70429

Journal: Physiological reports

Publication Date: 2025-6-17

Authors: Grönlund T, Kaikkonen K, Junttila MJ, Ukkola O, Kerkelä R, et al.

Key Points

• Higher HbA1c levels within normal and prediabetic ranges are associated with decreased myocardial contractility
• Proportion of subjects with abnormal global longitudinal strain increased from 7.4% to 21.1% across HbA1c groups (main effect p = 0.001)
• Early glycemic control and lifestyle modifications may be crucial for preventing subclinical cardiac dysfunction

Summary

This population-based study investigated the relationship between glycated hemoglobin (HbA1c) levels and left ventricular systolic function in a healthy middle-aged cohort, revealing that even within normal and prediabetic ranges, HbA1c levels are independently associated with reduced myocardial contractility. By examining 636 subjects aged 46, the researchers found a progressive decline in global longitudinal strain (GLS) as HbA1c levels increased, with the proportion of subjects showing abnormal GLS rising from 7.4% in the low HbA1c group to 21.1% in the high HbA1c group.

The study's findings suggest that glycemic control may impact cardiac function earlier than previously understood, potentially predicting future heart failure risk before traditional markers become apparent. Multivariate analysis identified sex, BMI, HbA1c, systolic blood pressure, and alcohol consumption as the most significant predictors of left ventricular systolic function, highlighting the complex interplay of metabolic and lifestyle factors in cardiac health.