Relationships between metabolic syndrome and left ventricular mass in hypertensive patients: does sex matter?

Abstract

Several studies documented an association between metabolic syndrome (MetS) and left ventricular (LV) hypertrophy. However, only in a few of these studies the impact of MetS on left ventricular mass (LVM) was separately analysed by gender, with conflicting results. The aim of our study was to verify, in a wide sample of essential hypertensive patients, the influence of gender, if any, on the relationship between MetS and LVM. We enrolled 475 non-diabetic subjects (mean age: 46 ± 11 years), with mild-to-moderate essential hypertension, of whom 40% had MetS, defined on the basis of Adult Treatment Panel III (ATPIII) criteria. All the patients underwent a 24-h ambulatory blood pressure monitoring and an echocardiogram. LVM indexed for height 2.7 (LVMH 2.7 ) was significantly (Po0.001) higher in women with MetS (n ¼ 83) than in those without it (n ¼ 97; 54 ± 17 vs 42±11 g m À2.7). An equally significant difference in LVMH 2.7 was documented also in male gender between the two groups with (n ¼ 105) and without MetS (n ¼ 190; 51 ± 14 vs 43±11 g m À2.7 ; Po0.001). The relationship between MetS and LVMH 2.7 remained statistically significant (Po0.001) in both sexes, in multiple regression analyses, even after adjustment for potential confounding factors. Our results seem to suggest that the relationship between MetS and LVM is not significantly affected by gender, being LVM increased in both hypertensive women and men with MetS.

Influence of gender on the relation between the metabolic syndrome and left ventricular mass

“…3 Indeed, in our study men with the metabolic syndrome had a significant 9% increase in LV mass index than men without the syndrome (50.3 vs 46.1 g  m À2.7 , P ¼ 0.002), whereas this difference was as large as 24% in women (49.5 vs 40.0 g  m À2.7 , Po0.001), and gender was found to be a significant effect modifier of the relation between the metabolic syndrome and LV mass. 3 However, a closer look at the data by Mulè et al 1 shows that the percent increase in LV mass in the subjects with the metabolic syndrome was more pronounced among women ( þ 27%) than among men ( þ 16%). Although not significant, the effect of the interaction term 'gender  metabolic syndrome' bordered statistical significance (P ¼ 0.10, in a multivariate model).…”

“…We read with interest the article by Mulè et al, 1 which explores the issue of the potential influence of gender on the relationship between the metabolic syndrome and and left ventricular (LV) mass. The Authors conclude that gender has no discernible effect on the above relation.…”

“…Although not significant, the effect of the interaction term 'gender  metabolic syndrome' bordered statistical significance (P ¼ 0.10, in a multivariate model). It is worth mentioning that about half of the 475 subjects examined by Mulè et al 1 had been receiving antihypertensive drug treatment up to 2 weeks before the study, and the effect of antihypertensive treatment on LV mass might have played a confounding role. Indeed, in the subgroup of 248 never-treated patients, the gender-specific difference was even greater ( þ 34.2% in women, þ 19.5% in men).…”

“…In addition, we believe that, on the whole, they also suggest that the effect of the metabolic syndrome might be greater in women than in men, although the effect might not be statistically significant in some of the studies. 1 …”

Metabolic syndrome and biventricular hypertrophy in essential hypertension

“…5 Diabetes mellitus accelerates the development of LVH in patients with essential hypertension independent of arterial pressure. 4 In this issue of the Journal of Human Hypertension, Cuspidi et al 6 show that metabolic syndrome (MS) also accelerates the development of LVH, as hypertensive patients of both genders had more cardiac alterations when they have MS.Earlier studies have shown that hypertensive patients with MS are more susceptible to develop LVH than those without MS. 7-10 Mule et al 9 showed in 475 non-diabetic subjects with mild-to-moderate essential hypertension, of whom 40% had MS, that left ventricular mass was significantly higher in those with MS than in those without it. The relationship between MS and left ventricular mass was not affected by gender.…”