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

Abstract

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...

Postmenopausal Status as Independent Risk Factor for Metabolic Syndrome

“…177 Interestingly, dietary salt restriction shows a more pronounced antihypertensive effect in elderly women than in men, again arguing in favor of a pathogenic role of cessation of endogenous estrogen production in the pathogenesis of salt sensitivity. 178 When target blood pressure cannot be achieved by the use of a single agent, the addition of a second drug from a different class should be initiated. This may be particularly important in postmenopausal women with MS, who often present with a more severe CV risk profile and show a less favorable response to antihypertensive therapy than their lean counterparts because of resistant hypertension.…”

Postmenopausal Hypertension

“…5 This may be particularly important in postmenopausal women with the metabolic syndrome, who often present with a more severe cardiovascular risk profile and show a less favorable response to antihypertensive therapy than their lean counterparts because of resistant hypertension. 81 The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers has been proposed in this context. 75,82 These drugs appear to be useful to antagonize the activation of the RAAS observed after menopause.…”

A Review on Metabolic Syndrome

“…Other studies showed that there is a high prevalence of metabolic syndrome among postmenopausal women, which varies from 32.6% to 41.5 % [24][25][26]. Study of Rossi et al [27] demonstrated that postmenopausal women with metabolic syndrome have lower incidence of cardiovascular risk factors. The mechanism behind the role of menopausal risk factors in initiating cardiovascular disease remains unclear [28].…”