Association Between Cortisol and Left Ventricular Diastolic Dysfunction in Patients With Diabetes Mellitus: A Case Control Study
Abstract Introduction: Diabetes mellitus (DM) is a major risk factor for the development of cardiovascular diseases. Heart failure with preserved ejection fraction is characterized by left ventricular diastolic dysfunction (LVDD). It has been reported that excess cortisol found in patients with Cushing’s syndrome was associated with the development of LVDD. However, the relationship between cortisol concentration and LVDD in patients with DM has not been addressed. Research Design and Methods: We enrolled 109 patients with DM and 104 patients without DM who had undergone echocardiographic examination at Kyushu University Hospital, Japan, between November 2016 and March 2019. Left ventricular function was evaluated and the ratio of early diastolic velocity from transmitral inflow to early diastolic velocity (E/eʹ) was used as an index of diastolic function. Plasma cortisol concentrations, glycemic control, lipid profiles, treatment with anti-diabetic drugs, and other clinical characteristics were evaluated, and their associations with E/eʹ were determined using univariate and multivariate analyses. Results Multivariate linear regression analysis showed that log E/eʹ was positively correlated with age (p = 0.017), log systolic blood pressure (p = 0.004), and cortisol (p = 0.037) and negatively correlated with eGFR (p = 0.016) and the usage of SGLT2 inhibitors (p = 0.042) in patients with DM. Multivariate analysis showed that cortisol was positively correlated with age (p = 0.016) and HbA1c (p = 0.011). There was no association between E/eʹ and cortisol in patients without DM. Conclusions Increased cortisol levels may increase the risk of developing LVDD in DM patients.