Electrocardiographic left ventricular hypertrophy in type 1 diabetes. Prevalence and relation to coronary heart disease and cardiovascular risk factors: The Eurodiab IDDM Complications Study

Objective: An excess of cardiovascular morbidity and mortality has been reported in subjects with left ventricular hypertrophy (LVH). We evaluated prevalence of ECG-LVH and associations with coronary heart disease, microvascular complications, QTc and QTd in people with type 1 diabetes. Research Design and Methods: 3113 type 1 diabetic patients across Europe were studied. LVH was defined by ECG Cornell voltage-duration product [(RaVL+SV3)xQRS duration] >2623 mm.ms in men and >1558.7 mm.ms in women. Results: Prevalence of ECG-LVH in the whole population was 3.4% (95% CI 2.8-4.1), higher in women than in men, even after adjustment for age, duration of diabetes, BMI, systolic and diastolic blood pressure and physical activity (4.6% vs 2.3%, OR=2.40, 95% CI 1.55-3.70). Subjects with ECG-LVH had significantly higher systolic and diastolic blood pressure, total cholesterol and triglycerides values than those without. Patients with CHD, hypertension, macroalbuminuria and prolonged QTc had significantly higher risk of ECG-LVH. A tendency towards decreasing risk of ECG-LVH with increasing estimated glucose disposal rate values was observed. In multivariate logistic regression analysis, variables independently related to ECG-LVH after adjustment for age, sex and diabetes duration were QTc>0.44s, CHD, triglycerides, WHR and systolic blood pressure. Conclusions: This population-based study shows: 1) a high prevalence of ECG-LVH in type 1 diabetic patients; 2) two-fold higher risk for ECG-LVH in women than in men; 3) the independent association of ECG-LVH with QTc, CHD, triglycerides, WHR and systolic blood pressure. The hypothesis that insulin-resistance is involved in risk of LVH in type 1 diabetic subjects is suggested.