Determinants of exercise capacity in T2D_DiabetesCare_R1_18.5.20_CLEAN.docx (128.69 kB)
Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes.
journal contributionposted on 2020-07-27, 14:28 authored by Gaurav S Gulsin, Joseph Henson, Emer M Brady, Jack A Sargeant, Emma G Wilmot, Lavanya Athithan, Zin Z Htike, Anna-Marie Marsh, John D Biglands, Peter Kellman, Kamlesh Khunti, David Webb, Melanie J Davies, Thomas Yates, Gerry P McCann
OBJECTIVE: To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure.
RESEARCH DESIGN AND METHODS: Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2. RESULTS: A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodelling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e') (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D.
CONCLUSIONS: In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.
This study was funded by the NIHR Research Trainees Coordinating Centre through a career development fellowship (CDF 2014-07-045 to G.P.M.), the British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/ 32190 to G.S.G.), the Medical Research Council through an Interdisciplinary Bridging Award, and Novo Nordisk.
CitationDiabetes Care 43 (8), 2020 Jul; dc200706. https://doi.org/10.2337/dc20-0706
Author affiliationDepartment of Cardiovascular Sciences
- AM (Accepted Manuscript)