Abstract
BACKGROUND: Left ventricular diastolic dysfunction (LVDD) precedes heart failure and may remain undetected in asymptomatic individuals. Early identification is particularly relevant in populations with cardiometabolic risk factors, where subclinical LVDD could refine risk stratification and guide preventive strategies. OBJECTIVE: To determine the prevalence of clinically significant LVDD (grade II-III) among asymptomatic adults aged 51-70 years and to compare its burden across major cardiovascular risk groups. METHODS: This retrospective cross‑sectional study analyzed 10,434 transthoracic echocardiograms performed over three years (between 1(st) October 2022 and 30(th )September 2025) at a tertiary cardiac center. A total of 5,482 asymptomatic individuals aged 51-70 years were included after exclusion of symptomatic patients and patients with structural heart disease, ejection fraction <50%, arrhythmias, and grade I LVDD. Participants were categorized into healthy controls, isolated hypertension, isolated diabetes mellitus, combined hypertension and diabetes mellitus, and severe obesity (BMI >40 kg/m²). Diastolic function was assessed using guideline‑based Doppler echocardiographic criteria, and only grade II-III LVDD was classified as clinically significant. RESULTS: Clinically significant LVDD was present in 102 healthy controls (3.7%, 95% CI: 3.0-4.5). Prevalence was higher in hypertension (13.1%, 95% CI: 11.4-15.0), diabetes mellitus (10.9%, 95% CI: 9.0-13.1), and combined hypertension plus diabetes (29.1%, 95% CI: 24.4-33.8). The highest prevalence occurred in severe obesity (53.5%, 95% CI: 34.1-72.2). LVDD prevalence increased stepwise across escalating cardiometabolic risk profiles. CONCLUSION: Clinically significant LVDD is uncommon in asymptomatic individuals without risk factors but substantially more prevalent in those with hypertension, diabetes, or severe obesity. The graded increase across risk categories underscores the cardiometabolic contribution to diastolic dysfunction. While routine screening of all asymptomatic individuals is not supported, targeted evaluation of high‑risk groups warrants further prospective investigation.