Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study

Cardiovasc Diabetol. 2017 May 12;16(1):64. doi: 10.1186/s12933-017-0542-6.


Background: Recent analyses in a registry of hypertensive patients suggested that preceding left ventricular (LV) hypertrophy (LVH) and/or carotid atherosclerosis are associated with incident type 2 diabetes, independent of confounders. We assess the relation between prevalent cardio-renal target organ damage (TOD) and subsequent incident type 2 diabetes in a population-based study with high prevalence of obesity.

Methods: We selected 2887 non-diabetic participants from two cohorts of the Strong Heart Study (SHS). Clinical exam, laboratory tests and echocardiograms were performed. Adjudicated TODs were LVH, left atrium (LA) dilatation, and high urine albumin/creatinine ratio (UACR). Multivariable logistic regression models were used to identify variables responsible for the association between initial TODs and incident diabetes at 4-year follow-up (FU).

Results: After 4 years, 297 new cases of diabetes (10%) were identified, 216 of whom exhibited baseline impaired fasting glucose (IFG, 73%, p < 0.0001). Participants developing type 2 diabetes exhibited higher inflammatory markers, fat-free mass and adipose mass and higher prevalence of initial LVH and LA dilatation than those without (both p < 0.04). In multivariable logistic regression, controlling for age, sex, family relatedness, presence of arterial hypertension and IFG, all three indicators of TOD predicted incident diabetes (all p < 0.01). However, the effects of TOD was offset when body fat and inflammatory markers were introduced into the model.

Conclusions: In this population-based study with high prevalence of obesity, TOD precedes clinical appearance of type 2 diabetes and is related to the preceding metabolic status, body composition and inflammatory status. Trial registration Trial registration number: NCT00005134, Name of registry: Strong Heart Study, URL of registry:, Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.

Keywords: Arterial hypertension; Body composition; Inflammation; Left atrial dilatation; Left ventricular hypertrophy; Target organ damage.

MeSH terms

  • Adiposity
  • Adult
  • Albuminuria / diagnosis
  • Albuminuria / epidemiology
  • Albuminuria / urine
  • Biomarkers / blood
  • Biomarkers / urine
  • Blood Glucose / metabolism
  • Chi-Square Distribution
  • Creatinine / urine
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Nephropathies / diagnosis
  • Diabetic Nephropathies / epidemiology*
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / urine
  • Disease Progression
  • Echocardiography, Doppler
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / epidemiology*
  • Hypertrophy, Left Ventricular / physiopathology
  • Incidence
  • Indians, North American
  • Inflammation Mediators / blood
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity / diagnosis
  • Obesity / epidemiology
  • Odds Ratio
  • Prevalence
  • Prognosis
  • Risk Factors
  • Time Factors
  • United States / epidemiology


  • Biomarkers
  • Blood Glucose
  • Inflammation Mediators
  • Creatinine

Associated data