Authors

Richard B. Devereux, Mary . Roman, Mary Paranicas,

Michael . OGrady, Elisa T. Lee, Thomas K. Welty,
Richard R Fabsitz, David Robbins, Everett R.
Rhoades, Barbara V. Howard
Group Members
Vishal H. Joseph | Marie T. Wambo | Treasure A.
James | Harini Sunder | Anitha Varghese
 Does Diabetes Mellitus
independently affect left ventricular
structure and function?
 Termed the Strong Heart Study (SHS), the
study attempts to establish DM as a strong risk
factor for cardiovascular morbidity and has
direct adverse effects on the heart.
The study employed cluster sampling for data
collection, from American Indian tribes in 4
neighbouring states within the U.S.A
50% of the participants selected had either
preexisting DM or a predisposition for the
development of DM (Genetic or lifestyle)
 Study was biased as participants were
generally older, mostly female, mostly from
Arizona(other states included N&S Dakota and
Oklahoma) and had preexisting HTN.
The 1 approach of assessing myocardial
efficiency and function incorporated
examination of LV systolic shortening in
relation to End Systolic Stress(ESS) w/ bpm.
 Mean interventricular septal and posterior LV
wall thicknesses found to be greater in diabetic
pts but very little variance between groups in
LV chamber size.
Older age and DM had independent +ve
associations w/ loss of or decreased cardiac
function as well as the incidence and
prevalence of HTN.
Limitation may be that the study was non-
invasive, resulting in the possibility of
deviation of results
 Follow-up on Kannel WB, et al. Diabetes and
glucose tolerance as risk factors for
cardiovascular disease; the Framingham
study. Diabetes Care. 1979-2;2:120-126
This report examined the relationship between
impaired glucose tolerance and the incidence of
cardiovascular disease. It was established that
impaired glucose tolerance is in fact a risk
factor associated with cardiac related mortality
and eliminating this risk factor greatly
decreased the risk of cardiovascular incidence.
 Fisher VJ, et al. Exercise testing with
myocardial scintiography in asymptomatic
diabetic males Circulation. 1981;63:54-64
On this study, 16 diabetic males with no
clinical or ECG evidence of heart disease were
put under maximal exercise stress test
compared with subjects with no history of
diabetes. Results showed that in 60% of the
diabetic patients, the presence of a myocardial
perfusion defect was detected compared to
only 6% on the non-diabetic test subjects.
 Cowan LD, et al. Adverse effects of diabetes
on multiple cardiovascular disease factors in
women: the Strong Heart Study Diabetes
Care. 1988;21:1258-1265
This study compared diabetes associated
differences in CVD risk in men and women.The
results showed that, in women, there was
greater adverse differences in the levels of
several CVD risk factors which really means
that CVD risk in diabetic women
issubstantially greater than in diabetic men.
 Diabetes Mellitus independently has adverse
effects on left ventricular structure and
function.

Null: Diabetes Mellitus independently does not

have adverse effects on left ventricular
structure and function.
The main objective of this research was to
determine whether Diabetes Mellitus has
adverse effects of left ventricular structure
independently of BMI increase and blood
pressure.
To also determine the actual effects that
Diabetes Mellitus has on the left ventricular
structure.
 This trial was a cluster, biased and convenient.
The participants were separated by gender due
to the high number of females who experience
DM.
Other variables were DM and non DM
participants.
97% of participants had a ECG.
The measurements from the ECG were made
with a computerized review station. Heart rate
was measured simultaneously.
 Variables were calculated with End diastolic
LV dimensions to get the LV mass.
Aortic annular cross sectional area was also
calculated.
LV performance was evaluated by taking
circumferential ESS. This variable is stress-
corrected midwall shortening.
 Cluster Sampling

Biased

Convenient
 A total of 3630 participants were subject to
testing in the initial survey.
This number of persons were selected as
representative of 1% of the total population of
the 4 states combined.
Given age and other factors such as loss of
cardiac function, the study ended with a total
of 3501 surviving participants; a solid 97% of
the original lot.
 Data was analysed using SPSS software.

Differences in results from DM and non-DM

groups were assessed by ANOVA (Analysis of
Variance) w/ consideration for covariates such
as sex and age.
 The hypothesis was established in Type 1 Diabetes
Mellitus and the objectives were met. Type 1 DM
has adverse effects on the ventricular structure
cardiac effects, including increased LV mass and
wall thicknesses, reduced LV systolic chamber and
myocardial function, and increased arterial
stiffness.
These findings identify adverse cardiovascular
effects of DM, independent of associated increases
in BMI and arterial pressure, that may contribute
to cardiovascular events in diabetic individuals.