Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women

Schillaci, Giuseppe; Pirro, Matteo; Pucci, Giacomo; Mannarino, Massimo Raffaele; Gemelli, F; Siepi, Donatella; Vaudo, Gaetano; Mannarino, Elmo

doi:10.1161/01.hyp.0000216778.83626.39

Cited by 103 publications

(101 citation statements)

References 54 publications

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“…Conversely, the lowest (o30%), although clinically relevant, rates of LVH are found in hypertensives surveyed in population-based studies 14,18,27 or in middle-aged, recently diagnosed, untreated hypertensives. 25,28,31,32,38 From these data, two considerations can be made: (1) a consistent fraction of treated hypertensive patients are still exposed to a high CV risk as antihypertensive treatment is unable to normalize BP and consequently reverse alterations in cardiac structure; (2) a noticeable portion of hypertensive patients (30%) enrolled in the examined studies were untreated, despite having a cardinal manifestation of organ damage such as LVH; this suggests that unsolved issues in primary prevention of CV disease include not only unsatisfactory BP control but also poor awareness of the hypertensive status and delay in hypertensive treatment.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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on behalf of the Italian Society of Hypertension Left-ventricular hypertrophy (LVH) is a cardinal manifestation of hypertensive organ damage associated with an increased cardiovascular (CV) risk. We reviewed recent literature on the prevalence of LVH, as assessed by echocardiography, in order to offer an updated information on the magnitude of subclinical alterations in LV structure in contemporary human hypertension. A MEDLINE search using key words 'left ventricular hypertrophy', 'hypertension', 'echocardiography' and 'cardiac organ damage' was performed in order to identify relevant papers. Full articles published in English language in the last decade, (1 January 2000 --1 December 2010), reporting studies in adult or elderly individuals, were considered. A total of 30 studies, including 37 700 untreated and treated patients (80.3% Caucasian, 52.4% men, 9.6% diabetics, 2.6% with CV disease) were considered. LVH was defined by 23 criteria; its prevalence ranged from 36% (conservative criteria) to 41% (less conservative criteria) in the pooled population. LVH prevalence was not different between women and men (range 37.9 --46.2 versus 36.0 --43.5%, respectively). Eccentric LVH was more frequent than concentric hypertrophy (range 20.3 --23.0 versus 14.8 --15.8, respectively, Po0.05); concentric phenotype was found in a consistent fraction (20%) of both genders. Despite the improved management of hypertension in the last two decades, LVH remains a highly frequent biomarker of cardiac damage in the hypertensive population. Our analysis calls for a more aggressive treatment of hypertension and related CV risk factors leading to LVH. INTRODUCTIONLeft ventricular hypertrophy (LVH) secondary to arterial hypertension is a complex cardiac phenotype resulting from the response of myocyte and non-myocyte components to mechanical and neuro-humoral stimuli. 1 Although the mechanisms underlying this process remain incompletely understood, available evidence from the last two decades indicates that chronic haemodynamic overload has a driving role in activating LV myocardial growth; in turn, non-haemodynamic variables (that is, genetic, ethnic, environmental and hormonal factors) modulate the extent (and type) of the hypertrophic response. 2 --4 LVH in hypertensive patients may be regarded as a powerful, independent biomarker reflecting the impact of pressure overload as well as of several risk factors 5 on the heart.Routinely assessed LVH by electrocardiography or more accurately by echocardiography, is a strong determinant of cardiovascular (CV) prognosis over and beyond conventional risk factors in both population-based studies and in selected hypertensive cohorts. 6 --8 Initial levels of LV mass and mass reduction during antihypertensive treatment define CV risk related to subclinical cardiac damage 9 and influence therapeutic strategies. 10 In recent years, observational and interventional studies addressing hypertensive LVH performed worldwide 5 --9,11,12 offered us the opportunity to update available information o...

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Section: Discussionmentioning

confidence: 99%

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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“…[24][25][26] This could potentially be explained by the observations that women with the MetS had stiffer arteries, 7,11,27 greater left ventricular mass and greater impairment of left ventricular function, 51,52 as compared with their male counterparts. In our study, however, no clear difference existed between men and women with regard to arterial stiffness, despite a single significant interaction term between the MetS and sex for the femoral compliance coefficient.…”

Section: Discussionmentioning

confidence: 99%

The metabolic syndrome in elderly individuals is associated with greater muscular, but not elastic arterial stiffness, independent of low-grade inflammation, endothelial dysfunction or insulin resistance—The Hoorn Study

et al. 2009

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The metabolic syndrome (MetS) increases cardiovascular disease (CVD) risk. How MetS increases CVD risk is incompletely understood, but increasing arterial stiffness is one candidate link, which in turn could be explained by (low-grade) inflammation, endothelial dysfunction (ED) or insulin resistance (IR). However, MetSrelated increases in stiffness may not be uniformly distributed over muscular and elastic arteries. Therefore, the purpose of this study was to determine: (1) the associations between the MetS, and muscular and elastic arterial stiffness, and (2) whether any such associations could be explained by inflammation, ED or IR. These questions were addressed in the Hoorn Study. MetS was defined according to the NCEP (National Cholesterol Education Program) criteria. Arterial stiffness was determined by ultrasound, tonometry and echocardiography. Inflammation, ED and IR were estimated by C-reactive protein, flow-mediated vasodilation and the homoeostatic model for the assessment of IR, respectively. The results showed that MetS was associated with both femoral and brachial arterial stiffness, significantly so for the distensibility coefficients and for the femoral compliance coefficient. In the carotid artery and aorta, no particular pattern emerged. Additional adjustment for either inflammation, ED or IR did not materially alter the results. The results therefore indicate that muscular arteries may stiffen preferentially over elastic arteries and that distensibility is affected to a greater extent than compliance, thus maintaining volume compliance over vessel wall stiffening. Additionally, the increase in stiffness was not explained by inflammation, ED or IR and suggests that stiffening of the muscular arteries in MetS may not be the consequence of these phenomena.

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“…Many studies identify MS, especially in postmenopausal women, as an important risk factor for cardiovascular and cerebrovascular disease. 9,17,18 Several studies have shown that insulin resistance/hyperinsulinemia, a hallmark of MS, is a predictor of ischemic heart disease in the population at large 19,20 -22 and in patients with type II diabetes. 23 High BP is a major and independent cardiovascular risk factor.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome Affects Cardiovascular Risk Profile and Response to Treatment in Hypertensive Postmenopausal Women

et al. 2008

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Abstract-Metabolic syndrome is increasingly recognized as an important cardiovascular risk factor in hypertension, but its influence on the cardiovascular risk profile in hypertensive postmenopausal women has not been studied. The aim of the present study was to investigate the impact of metabolic syndrome on the cardiovascular risk profile and the response to treatment. We enrolled 350 hypertensive postmenopausal women, 55Ϯ6 years of age (range 47 to 60 years of age). Patients were divided into 2 groups according to the presence of metabolic syndrome. Compared with those without, women with metabolic syndrome had higher waist circumference, body mass index, and levels of glucose, triglycerides, and HDL cholesterol, as would be expected, based on definition. In addition, patients with metabolic syndrome had a cardiovascular risk profile less favorable, characterized by a significantly higher highly sensitive C-reactive protein (2.2Ϯ0.6 versus 1.7Ϯ0.7 ng/L; PϽ0.01), a more compromised endothelial function (flow-mediated vasodilation 2.4Ϯ2.2 versus 4.4Ϯ2.5%; Pϭ0.01), and a significantly higher left ventricular mass (44Ϯ15 versus 41Ϯ16 g/m 2.7 ). Also, antihypertensive treatment induced a more modest improvement of both endothelial dysfunction and subclinical inflammation in women with metabolic syndrome. The results of our study show that in postmenopausal women, there are 2 different forms of hypertension: that which is isolated, and that which is associated with metabolic syndrome. This last form is related to a more severe risk profile, and response to therapy is less favorable. Key Words: women Ⅲ metabolic syndrome Ⅲ hypertension Ⅲ cardiovascular diseases Ⅲ drugs Ⅲ risk factors H ypertension is highly prevalent in postmenopausal women, and the postmenopausal period is a wellestablished risk factor for cardiovascular disease in women. 1 As one example of this phenomenon, the prevalence of hypertension is higher in males 30 to 45 years of age than in females of similar age, whereas the prevalence of hypertension in females after this age increases to levels similar to 2 or exceeding that 3 in males. Hypertension can be considered an isolated disease or part of the metabolic syndrome (MS). MS, a clustering of lipid and nonlipid cardiovascular risk factors, is estimated to affect Ϸ20% to 30% of the middle-aged population, 4 and the prevalence of the disorder appears to be increasing in the US population. 5 Postmenopausal status is associated with a 60% increased risk of MS, even after adjusting for confounding variables. 6 MS is increasingly recognized as an independent predictor of cardiovascular disease in hypertension. 7 Moreover, in those studies in which the prognostic impact of MS has been examined separately in men and women, the coronary or cardiovascular morbidity/mortality hazard ratios associated with MS were almost invariably found to be higher in the female sex. 8 -10 Therefore, the risk of cardiovascular disease attributed to MS appears to be especially high in women, and it is estimated that half o...

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Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women

Cited by 103 publications

References 54 publications

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

The metabolic syndrome in elderly individuals is associated with greater muscular, but not elastic arterial stiffness, independent of low-grade inflammation, endothelial dysfunction or insulin resistance—The Hoorn Study

Metabolic Syndrome Affects Cardiovascular Risk Profile and Response to Treatment in Hypertensive Postmenopausal Women

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