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Wang C, Liang L, Luo S, Wang H, Wang X, Cheng Y, Pan G, Peng J, Han S, Wang X. Nomogram-based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers. J Clin Hypertens (Greenwich) 2024; 26:363-373. [PMID: 38430459 PMCID: PMC11007794 DOI: 10.1111/jch.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.
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Affiliation(s)
- Chuang‐chang Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Li‐Keng Liang
- Yunkang school of medicine and healthNanfang CollegeGuangzhouChina
| | - Sheng‐ming Luo
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐Cheng Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xiao‐li Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Ya‐Hui Cheng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Guang‐ming Pan
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Jiang‐Yang Peng
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Shu‐jie Han
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Xia Wang
- Department of CardiovascularThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- Applicants with the same educational background for master's degreeThe Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouChina
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Kim HL, Joo HJ, Lim WH, Seo JB, Kim SH, Zo JH, Lim DS, Kim MA. Association Between Metabolic Syndrome and Parameters of Subclinical Target Organ Damage in Urban Subjects Without Documented Cardiovascular Disease. Metab Syndr Relat Disord 2020; 18:373-380. [PMID: 32721264 DOI: 10.1089/met.2020.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Identification of subclinical target organ damage (TOD) at early stage is important for the reduction in cardiovascular risk. This study was performed to assess the association between metabolic syndrome (MetS) and several types of TOD in urban people. Methods: Data from 958 Korean subjects without cardiovascular disease, living in Seoul city (mean age, 55.2 years, 47.6% males), were extracted from the prospective cohort database. All participants underwent extensive evaluation of TOD parameters, including left ventricular mass index (LVMI), E/e', brachial-ankle pulse wave velocity (baPWV), estimated glomerular filtration rate (eGFR), ankle-brachial index (ABI), carotid intima-media thickness (IMT), and obstructive coronary artery disease. Results: MetS and ≥1 TOD were detected in 494 (51.5%) and 329 (34.3%) subjects, respectively. There were no significant differences in the prevalence of ≥1 TOD according to the presence of MetS (P > 0.05). Among MetS components, only high blood pressure was associated with ≥1 TOD (69.6% vs. 59.9%, P = 0.004). There was a positive association between ≥1 TOD and the number of MetS traits (P = 0.034). There were significant linear correlations of Z-score of MetS with baPWV (r = 0.241, P < 0.001) and eGFR (r = -0.173, P < 0.001) but not with LVMI, E/e', ABI, and carotid IMT (P > 0.05 for each). Conclusions: In urban Korean population without cardiovascular disease, TOD is more closely related to the number of risk factors meeting MetS criteria and high blood pressure than the presence of MetS itself.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
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Doneddu A, Roberto S, Pinna V, Magnani S, Ghiani G, Sainas G, Mulliri G, Serra S, Kakhak SAH, Milia R, Lecis R, Guicciardi M, Crisafulli A. Effect of Combined Mental Task and Metaboreflex Activation on Hemodynamics and Cerebral Oxygenation in Patients With Metabolic Syndrome. Front Physiol 2020; 11:397. [PMID: 32477157 PMCID: PMC7241117 DOI: 10.3389/fphys.2020.00397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/02/2020] [Indexed: 01/26/2023] Open
Abstract
Objective: The hemodynamic response to muscle metaboreflex has been reported to be significantly altered by metabolic syndrome (MS), with exaggerated systemic vascular resistance (SVR) increments and reduced cardiac output (CO) in comparison to healthy controls (CTLs). Moreover, patients with metabolic disorders, such as type 2 diabetes, have proven to have impaired cerebral blood flow in response to exercise. Thus, we hypothesized that contemporary mental task (MT) and metaboreflex would result in reduced cerebral oxygenation (COX) in these patients. Methods: Thirteen MS patients (five women) and 14 normal age-matched CTLs (six women) were enrolled in this study. All the participants underwent five different tests, each lasting 12 min: post-exercise muscle ischemia (PEMI) to activate the metaboreflex, control exercise recovery (CER), PEMI + MT, CER + MT, and MT alone. Cerebral oxygenation was evaluated using near-infrared spectroscopy with sensors applied to the forehead. Hemodynamics were measured using impedance cardiography. Results: The main results show that MS patients had higher SVR and lower CO levels compared to the CTL group during metaboreflex activation. Stroke volume and ventricular filling and emptying rates were also significantly reduced. Moreover, when MT was added to PEMI, COX was significantly increased in the CTL group with respect to the baseline (103.46 ± 3.14%), whereas this capacity was reduced in MS patients (102.37 ± 2.46%). Conclusion: It was concluded that (1) patients with MS showed hemodynamic dysregulation during the metaboreflex, with exaggerated vasoconstriction and that (2) as compared to CTL, MS patients had reduced capacity to enhance COX when an MT superimposed the metaboreflex.
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Affiliation(s)
- Azzurrra Doneddu
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Virginia Pinna
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Sara Magnani
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Giovanna Ghiani
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Gianmarco Sainas
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Gabriele Mulliri
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Stefano Serra
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | | | - Raffaele Milia
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy
| | - Romina Lecis
- Department of Pedagogy, Psychology, and Philosophy, University of Cagliari, Cagliari, Italy
| | - Marco Guicciardi
- Department of Pedagogy, Psychology, and Philosophy, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy.,International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
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Abstract
OBJECTIVE The aim of this study was to evaluate the influence of sex on left ventricular mechanics in hypertensive individuals. METHODS This cross-sectional study included 171 untreated hypertensive patients and 112 normotensive controls who underwent a 24-h ambulatory blood pressure monitoring and comprehensive echocardiographic examination including strain assessment. RESULTS Hypertensive women and men had significantly lower left ventricular global longitudinal and circumferential strains than their normotensive counterparts. Left ventricular global longitudinal strain was lower in hypertensive men than in women (-19.8 ± 2.2 vs. -17.9 ± 2.1%; P < 0.01). Left ventricular global circumferential strain was also reduced in hypertensive men in comparison with women (-21.0 ± 2.5 vs. -18.7 ± 2.3%; P < 0.01). The difference in left ventricular radial strain was not discovered between hypertensive women and men. Furthermore, left ventricular twist was significantly higher in hypertensive women than in hypertensive men (21.9 ± 4.1° vs. 20.6 ± 3.8°; P = 0.034). Female sex and arterial hypertension, and also their interaction, were associated with lower left ventricular mass index, increased left ventricular global longitudinal, and circumferential strains and increased left ventricular twist compared with hypertensive men. CONCLUSION Left ventricular longitudinal and circumferential strains were significantly reduced in hypertensive patients. However, the changes are more pronounced in hypertensive men than in women. Sex has a significant effect on the association between hypertension, and longitudinal and circumferential strain.
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Changes in hemodynamics associated with metabolic syndrome are more pronounced in women than in men. Sci Rep 2019; 9:18377. [PMID: 31804574 PMCID: PMC6895092 DOI: 10.1038/s41598-019-54926-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/18/2019] [Indexed: 01/09/2023] Open
Abstract
The increase in cardiovascular risk associated with metabolic syndrome (MS) seems higher in women than in men. We examined hemodynamics during head-up tilt in 252 men and 250 women without atherosclerosis, diabetes, or antihypertensive medication, mean age 48 years, using whole-body impedance cardiography and radial pulse wave analysis. MS was defined according to Alberti et al. 2009. Men and women with MS presented with corresponding elevations of systolic and diastolic blood pressure (10-14%, p ≤ 0.001) versus controls. Supine pulse wave velocity (16-17%, p < 0.001) and systemic vascular resistance (7-9%, p ≤ 0.026), and upright cardiac output (6-11%, p ≤ 0.008) were higher in both MS groups than controls. Elevation of supine aortic characteristic impedance was higher in women than in men with MS (16% vs. 8%, p = 0.026), and in contrast to men, no upright impedance reduction was observed in women. When upright, women but not men with MS showed faster return of reflected pressure wave (p = 0.036), and smaller decrease in left cardiac work (p = 0.035) versus controls. The faster upright return of reflected pressure, lower upright decrease in left cardiac work, and higher elevation of aortic characteristic impedance may contribute to the greater increase in MS-related cardiovascular risk in women than in men.
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Mercurio V, Pucci G, Bosso G, Fazio V, Battista F, Iannuzzi A, Brambilla N, Vitalini C, D'Amato M, Giacovelli G, Vaudo G, Schillaci G, Galletti F, Bonaduce D. A nutraceutical combination reduces left ventricular mass in subjects with metabolic syndrome and left ventricular hypertrophy: A multicenter, randomized, double-blind, placebo-controlled trial. Clin Nutr 2019; 39:1379-1384. [PMID: 31371114 DOI: 10.1016/j.clnu.2019.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Increased left ventricular mass (LVM) is often present in metabolic syndrome (MS), also in the setting of well-controlled blood pressure (BP). Aim of the present study was to evaluate the efficacy of a nutraceutical combination of berberine, red yeast rice extract and policosanol (Armolipid Plus™, AP) in reducing LVM in patients with MS and left ventricular hypertrophy (LVH). METHODS In this multicenter, randomized, double-blind, placebo-controlled trial, 158 patients with MS (IDF criteria) and LVH (LVM > 48 g/m2.7 in men and > 44 g/m2.7 in women), were randomized 1:1 to receive AP or placebo for 24 weeks. Reduction of LVM, regression of LVH, and changes in lipids were analysed. RESULTS One-hundred-and-forty-five patients (AP n = 74, placebo n = 71) completed the study. A significant percentage reduction in LVM was observed in AP group vs baseline (-2.7%, p < 0.0001), and compared to placebo (-4.1%, p < 0.0001), and remained significant after adjustment for age, sex, baseline systolic BP and BMI and their changes during the study period. The proportion of subjects showing LVM reduction was higher in AP group than in the placebo group (57% vs 28%, adjusted p = 0.007). Treatment with AP was associated with improvement of lipid profile. CONCLUSIONS 24-week of treatment with AP is associated with a significant reduction in LVM in subjects with MS and LVH, in addition to favourable effects on lipid profile, and could represent an effective strategy aiming at reducing the associated cardiovascular risk. The trial was registered at clinicaltrials.gov with ID NCT02295176.
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Affiliation(s)
- Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University of Naples, Italy.
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy
| | - Giorgio Bosso
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | - Valeria Fazio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Francesca Battista
- Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy
| | - Angela Iannuzzi
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
| | | | | | | | | | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy
| | - Giuseppe Schillaci
- Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, Federico II University of Naples, Italy
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Roberto S, Milia R, Doneddu A, Pinna V, Palazzolo G, Serra S, Orrù A, Hosseini Kakhak SA, Ghiani G, Mulliri G, Pagliaro P, Crisafulli A. Hemodynamic abnormalities during muscle metaboreflex activation in patients with type 2 diabetes mellitus. J Appl Physiol (1985) 2018; 126:444-453. [PMID: 30543497 DOI: 10.1152/japplphysiol.00794.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Metaboreflex is a reflex triggered during exercise or postexercise muscle ischemia (PEMI) by metaboreceptor stimulation. Typical features of metaboreflex are increased cardiac output (CO) and blood pressure. Patients suffering from metabolic syndrome display hemodynamic abnormalities, with an exaggerated systemic vascular resistance (SVR) and reduced CO response during PEMI-induced metaboreflex. Whether patients with type 2 diabetes mellitus (DM2) have similar hemodynamic abnormalities is unknown. Here we contrast the hemodynamic response to PEMI in 14 patients suffering from DM2 (age 62.7 ± 8.3 yr) and in 15 age-matched controls (CTLs). All participants underwent a control exercise recovery reference test and a PEMI test to obtain the metaboreflex response. Central hemodynamics were evaluated by unbiased operator-independent impedance cardiography. Although the blood pressure response to PEMI was not significantly different between the groups, we found that the SVR and CO responses were reversed in patients with DM2 as compared with the CTLs (SVR: 392.5 ± 549.6 and -14.8 ± 258.9 dyn·s-1·cm-5; CO: -0.25 ± 0.63 and 0.46 ± 0.50 l/m, respectively, in DM2 and in CTL groups, respectively; P < 0.05 for both). Of note, stroke volume (SV) increased during PEMI in the CTL group only. Failure to increase SV and CO was the consequence of reduced venous return, impaired cardiac performance, and augmented afterload in patients with DM2. We conclude that patients with DM2 have an exaggerated vasoconstriction in response to metaboreflex activation not accompanied by a concomitant increase in heart performance. Therefore, in these patients, blood pressure response to the metaboreflex relies more on SVR increases rather than on increases in SV and CO. NEW & NOTEWORTHY The main new finding of the present investigation is that subjects with type 2 diabetes mellitus have an exaggerated vasoconstriction in response to metaboreflex activation. In these patients, blood pressure response to the metaboreflex relies more on systemic vascular resistance than on cardiac output increments.
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Affiliation(s)
- Silvana Roberto
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Raffaele Milia
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Azzurra Doneddu
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Virginia Pinna
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Girolamo Palazzolo
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Stefano Serra
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Andrea Orrù
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | | | - Giovanna Ghiani
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Gabriele Mulliri
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Pasquale Pagliaro
- Cardiovascular Physiology Laboratory, Department of Clinical and Biological Science, University of Torino , Turin , Italy
| | - Antonio Crisafulli
- Sports Physiology Laboratory, Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
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Kangas P, Tikkakoski A, Uitto M, Viik J, Bouquin H, Niemelä O, Mustonen J, Pörsti I. Metabolic syndrome is associated with decreased heart rate variability in a sex-dependent manner: a comparison between 252 men and 249 women. Clin Physiol Funct Imaging 2018; 39:160-167. [PMID: 30307694 DOI: 10.1111/cpf.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Abstract
Impaired heart rate variability (HRV) is associated with increased risk of cardiovascular disease, but evidence regarding alterations of HRV in metabolic syndrome (MetS) remains elusive. In order to examine HRV in MetS, we subjected 501 volunteers without atherosclerosis, diabetes or antihypertensive medication, mean age 48 years, to passive head-up tilt. The subjects were divided to control men (n = 131), men with MetS (n = 121), control women (n = 191) and women with MetS (n = 58) according to the criteria by Alberti et al. (Circulation, 2009, 120, 1640). In unadjusted analyses (i) men and women with MetS had lower total power and high-frequency (HF) power of HRV than controls whether supine or upright (P<0·05 for all). (ii) Supine low-frequency (LF) power of HRV was lower in men (P = 0·012) but not in women (P = 0·064) with MetS than in controls, while men and women with MetS had lower upright LF power of HRV than controls (P <0·01 for both). (iii) The LF:HF ratio did not differ between subjects with and without MetS. After adjustment for age, smoking habits, alcohol intake, height, heart rate and breathing frequency, only the differences in upright total power and HF power of HRV between women with MetS and control women remained significant (P<0·05). In conclusion, reduced total and HF power of HRV in the upright position may partially explain why the relative increase in cardiovascular risk associated with MetS is greater in women than in men. Additionally, the present results emphasize that the confounding factors must be carefully taken into consideration when evaluating HRV.
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Affiliation(s)
- Pauliina Kangas
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Marko Uitto
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Jari Viik
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Heidi Bouquin
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Cífková R. Left ventricular hypertrophy in females with hypertension is associated with a poor prognosis. Int J Cardiol 2018; 258:277-278. [PMID: 29544943 DOI: 10.1016/j.ijcard.2018.01.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Czech Republic.
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11
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Li T, Chen S, Guo X, Yang J, Sun Y. Impact of hypertension with or without diabetes on left ventricular remodeling in rural Chinese population: a cross-sectional study. BMC Cardiovasc Disord 2017; 17:206. [PMID: 28750662 PMCID: PMC5531001 DOI: 10.1186/s12872-017-0642-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to assess the impact of hypertension with or without diabetes on left ventricular (LV) remodeling in rural Chinese population. Methods A total of 10,270 participants were classified into control group, hypertension without diabetes (HT) group, and hypertension with diabetes (HT + DM) group. We compared clinical characteristics and echocardiographic parameters, and used multivariable logistic regression analysis to assess the associations of interest. Results HT + DM group had higher interventricular septal thickness (IVSd), posterior wall thickness (PWTd), left ventricular mass (LVM), LVM index (LVMI), relative wall thickness (RWT), left atrial diameter (LAD), A wave and lower E wave than HT group (all P < 0.05). The prevalence rates of left ventricular hypertrophy (LVH) and abnormal geometry were statistically different among three groups (P < 0.001) and eccentric hypertrophy was the highest proportion of geometry abnormality. Logistic regression analysis suggested that subjects in HT and HT + DM groups had odds ratio (OR) values of 2.81, 4.41, 2.24 and 3.94, 7.20, 2.38 for LVH, concentric hypertrophy and eccentric hypertrophy in the total population, respectively, compared to control group. When compared with HT group, those in HT + DM group had approximately 1.40-, 1.61- and 1.38-, 1.71-fold increased risk for LVH and concentric hypertrophy in the total and female population separately, but no association of HT + DM with LVH and abnormal geometrical patterns was found in men. Conclusions This study demonstrated that, to varying degrees, hypertension was associated with LV remodeling in rural Chinese population, and this risk association was obviously increased for LVH and concentric hypertrophy when accompanied by diabetes, especially for women.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Shuang Chen
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
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12
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Al-Daydamony MM, El-Tahlawi M. What Is the Effect of Metabolic Syndrome without Hypertension on Left Ventricular Hypertrophy? Echocardiography 2016; 33:1284-9. [DOI: 10.1111/echo.13247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Mohammad El-Tahlawi
- Cardiology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
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Pressure-independent relationship of aortic characteristic impedance with left ventricular mass and geometry in untreated hypertension. J Hypertens 2016; 33:153-60. [PMID: 25269017 DOI: 10.1097/hjh.0000000000000354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
METHOD We investigated whether aortic characteristic impedance (Zc), that is, the ratio between the pulsatile change in pressure and flow in the proximal aorta, is related to left ventricular hypertrophy and geometry independently of blood pressure (BP). A total of 438 never-treated hypertensive individuals (men 62%, age 48 ± 11 years, BP 147/90 ± 16/10 mm Hg) underwent echocardiography and 24 h BP monitoring. Aortic pressure waveform was obtained from radial tonometry with a generalized transfer function (SphygmoCor). Using a validated aortic blood flow model based on higher order Windkessel theory (ARCSolver), aortic Zc, forward (Pf) and backward (Pb) wave amplitudes and their ratio (Pb/Pf = reflection magnitude) were calculated from central waveform. RESULTS After adjusting for age, BMI, and 24-h SBP, aortic Zc was higher in individuals with left ventricular hypertrophy (0.230 ± 0.09 vs. 0.205 ± 0.07 arbitrary units, P = 0.04 in women; 0.232 ± 0.07 vs. 0.214 ± 0.06 arbitrary units, P < 0.05 in men). Women with left ventricular concentric remodeling had higher adjusted Zc (0.225 ± 0.08 vs. 0.203 ± 0.07 arbitrary units, P = 0.04), whereas men did not differ (0.218 ± 0.07 vs. 0.218 ± 0.07 arbitrary units, P = 0.64). After controlling for age, BMI, 24 h SBP, and other relevant variables, aortic Zc independently predicted left ventricular mass (β = 0.14, P < 0.05) and relative wall thickness (β = 0.21, P < 0.01) in women, and left ventricular mass in men (β = 0.11, P < 0.05), whereas other arterial function parameters had no independent relation with left ventricular mass or geometry. CONCLUSION Aortic Zc has a significant association with left ventricular mass and a sex-specific one with left ventricular concentric geometry in hypertension. These effects are independent from, and additional to, those of 24 h SBP.
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Milia R, Velluzzi F, Roberto S, Palazzolo G, Sanna I, Sainas G, Pusceddu M, Mulliri G, Loviselli A, Crisafulli A. Differences in hemodynamic response to metaboreflex activation between obese patients with metabolic syndrome and healthy subjects with obese phenotype. Am J Physiol Heart Circ Physiol 2015; 309:H779-89. [DOI: 10.1152/ajpheart.00250.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/30/2015] [Indexed: 01/07/2023]
Abstract
Patients suffering from obesity and metabolic syndrome (OMS) manifest a dysregulation in hemodynamic response during exercise, with an exaggerated systemic vascular increase. However, it is not clear whether this is the consequence of metabolic syndrome per se or whether it is due to concomitant obesity. The aim of the present investigation was to discover whether OMS and noncomplicated obesity resulted in different hemodynamic responses during the metaboreflex. Twelve metabolically healthy but obese subjects (MHO; 7 women), 13 OMS patients (5 women), and 12 normal age-matched controls (CTL; 6 women) took part in this study. All participants underwent a postexercise muscle ischemia protocol to evaluate the metaboreflex activity. Central hemodynamics were evaluated by impedance cardiography. The main result shows an exaggerated increase in systemic vascular resistance from baseline during the metaboreflex in the OMS patients as compared with the other groups (481.6 ± 180.3, −0.52 ± 177.6, and −60.5 ± 58.6 dynes·s−1·cm−5 for the OMS, the MHO, and the CTL groups, respectively; P < 0.05). Moreover, the MHO subjects and the CTL group showed an increase in cardiac output during the metaboreflex (288.7 ± 325.8 and 703.8 ± 276.2 ml/m increase with respect to baseline), whereas this parameter tended to decrease in the OMS group (−350 ± 236.5 ml/m). However, the blood pressure response, which tended to be higher in the OMS patients, was not statistically different between groups. The results of the present investigation suggest that OMS patients have an exaggerated vasoconstriction in response to metaboreflex activation and that this fact is not due to obesity per se.
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Affiliation(s)
- Raffaele Milia
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
| | - Fernanda Velluzzi
- The Obesity Center of the Department of Medical Sciences of the University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
- The Obesity Center of the Department of Medical Sciences of the University of Cagliari, Cagliari, Italy
| | - Girolamo Palazzolo
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
| | - Irene Sanna
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
| | - Gianmarco Sainas
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
- The Obesity Center of the Department of Medical Sciences of the University of Cagliari, Cagliari, Italy
| | - Matteo Pusceddu
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
| | - Gabriele Mulliri
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
- The Obesity Center of the Department of Medical Sciences of the University of Cagliari, Cagliari, Italy
| | - Andrea Loviselli
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
- The Obesity Center of the Department of Medical Sciences of the University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- From the Sports Physiology Laboratory, University of Cagliari, Cagliari, Italy; and
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Combination of hyperuricemia and metabolic syndrome is an independent and powerful predictor for left ventricular hypertrophy in rural Chinese. ANNALES D'ENDOCRINOLOGIE 2015; 76:264-71. [PMID: 26141680 DOI: 10.1016/j.ando.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/20/2014] [Accepted: 01/09/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the influence of MetS (metabolic syndrome) in combination with hyperuricemia on left ventricular hypertrophy (LVH) in residents in the rural area of Northeast China. METHODS We performed a cross-sectional baseline data analysis of 11,170 subjects (mean age: 54±11years) recruited from the rural area of China. Anthropometric indicators were measured according to standard methods. MetS was defined by the ATP III modified criteria. Hyperuricemia was defined according to sex-specific serum uric acid levels (SUA): SUA≥7.0mg/dL for male and≥6.0mg/dL for female. Four groups were listed: normouricemia non-MetS, hyperuricemia non-MetS, MetS normouricemia and hyperuricemia MetS. RESULTS Left ventricular mass index for height(2.7) (LVMH(2.7)) in female was significantly higher in hyperuricemia MetS group than that in normouricemia non-MetS (52.43±16.60 vs. 40.04±10.72g/m(2.7), P<0.001) group. Similar result was observed in men (48.93±13.17g/m(2.7) vs. 43.63±11.90g/m(2.7), P<0.001). The result of multiple regression analysis indicated that hyperuricemia MetS group had higher risk of LVH than other three groups (OR: 3.427 for female, P<0.001, OR: 1.987 for male, P<0.001). Moreover, female subjects in MetS normouricemia group [OR (95% CI): 2.313 (1.991-2.686)] had greater risk of LVH than that in hyperuricemia non-MetS group [OR (95% CI): 1.917 (1.166-3.151)]. Hyperuricemia non-MetS was found to be significantly and independently associated with LVH in women, but not in men. CONCLUSION Our study finds that the combination of hyperuricemia and MetS are independent and powerful predictor for LVH in rural area of Northeast Chinese. Women with MetS in combination with hyperuricemia have higher risk of LVH than men. It seems that MetS has greater effect on LVH than hyperuricemia does in women but not in men.
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Ratto E, Viazzi F, Verzola D, Bonino B, Gonnella A, Parodi EL, Bezante GP, Leoncini G, Pontremoli R. Metabolic syndrome is associated with left ventricular dilatation in primary hypertension. J Hum Hypertens 2015; 30:158-63. [PMID: 26108365 DOI: 10.1038/jhh.2015.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 12/11/2022]
Abstract
Metabolic syndrome (MS) has been shown to predict cardiovascular events in hypertension. Recently, a new four-group left ventricular (LV) hypertrophy classification based on both LV dilatation and concentricity was proposed. This classification has been shown to provide a more accurate prediction of cardiovascular events, suggesting that the presence of LV dilatation may add prognostic information. We investigated the relationship between MS and the new classification of LV geometry in patients with primary hypertension. A total of 372 untreated hypertensive patients were studied. Four different patterns of LV hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The overall prevalence of MS and LV hypertrophy (LVH) was 29% and 61%, respectively. Patients with MS showed a higher prevalence of LVH (P=0.0281) and dilated LV geometries, namely eccentric dilated and concentric dilated hypertrophy (P=0.0075). Moreover, patients with MS showed higher LV end-diastolic volume (P=0.0005) and prevalence of increased LV end-diastolic volume (P=0.0068). The prevalence of LV chamber dilatation increased progressively with the number of components of MS (P=0.0191). Logistic regression analysis showed that the presence of MS entails a three times higher risk of having LV chamber dilatation even after adjusting for several potential confounding factors. MS is associated with LV dilatation in hypertension. These findings may, in part, explain the unfavourable prognosis observed in patients with MS.
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Affiliation(s)
- E Ratto
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - F Viazzi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - D Verzola
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - B Bonino
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - A Gonnella
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - E L Parodi
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - G P Bezante
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - G Leoncini
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - R Pontremoli
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
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17
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Cross-sectional analysis of serum calcium levels for associations with left ventricular hypertrophy in normocalcemia individuals with type 2 diabetes. Cardiovasc Diabetol 2015; 14:43. [PMID: 25924883 PMCID: PMC4422420 DOI: 10.1186/s12933-015-0200-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/15/2015] [Indexed: 01/19/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH) is prevalent in patients with type 2 diabetes mellitus (T2DM). Recent studies show that an increase in albumin-adjusted serum calcium level is associated with an elevated risk of T2DM. We speculate that increased serum calcium levels in T2DM patients are related to LVH prevalence. Methods In this echocardiographic study, 833 normocalcemia and normophosphatemia patients with T2DM were enrolled. The associations between serum calcium and metabolic parameters, left ventricular mass index (LVMI), as well as the rate of LVH were examined using bivariate linear correlation, multivariate linear regression and logistic regression, respectively. The predictive performance of serum calcium for LVH was evaluated using the area under the receiver operating characteristic curve (AUC). Results Patients with LVH have significantly higher serum calcium than those without LVH. Serum calcium was positively associated with total cholesterol, triglycerides, low-density lipoprotein cholesterol, serum uric acid, HOMA-IR and fasting plasma glucose. Multivariate linear regression analysis demonstrated that serum calcium was independently associated with LVMI (p < 0.001). In comparison with patients in the lowest serum calcium quartile, the odds ratio (OR) for LVH in patients in the highest quartile was 2.909 (95% CI 1.792-4.720; p < 0.001). When serum calcium was analyzed as a continuous variable, per 1 mg/dl increase, the OR (95% CI) for LVH was [2.400 (1.552-3.713); p < 0.001]. Serum calcium can predict LVH (AUC = 0.617; 95% CI (0.577-0.656); p < 0.001). Conclusions Albumin-adjusted serum calcium is associated with an increased risk of LVH in patients with T2DM.
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Bostick B, Habibi J, DeMarco VG, Jia G, Domeier TL, Lambert MD, Aroor AR, Nistala R, Bender SB, Garro M, Hayden MR, Ma L, Manrique C, Sowers JR. Mineralocorticoid receptor blockade prevents Western diet-induced diastolic dysfunction in female mice. Am J Physiol Heart Circ Physiol 2015; 308:H1126-35. [PMID: 25747754 DOI: 10.1152/ajpheart.00898.2014] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/23/2015] [Indexed: 12/15/2022]
Abstract
Overnutrition/obesity predisposes individuals, particularly women, to diastolic dysfunction (DD), an independent predictor of future cardiovascular disease. We examined whether low-dose spironolactone (Sp) prevents DD associated with consumption of a Western Diet (WD) high in fat, fructose, and sucrose. Female C57BL6J mice were fed a WD with or without Sp (1 mg·kg(-1)·day(-1)). After 4 mo on the WD, mice exhibited increased body weight and visceral fat, but similar blood pressures, compared with control diet-fed mice. Sp prevented the development of WD-induced DD, as indicated by decreased isovolumic relaxation time and an improvement in myocardial performance (<Tei index) and septal annular velocity (<E'-to-A' ratio), as assessed by echocardiography, as well as decreased diastolic relaxation time/increased diastolic initial filling rate, as assessed by MRI. The relationship between passive sarcomere length of cardiac myocytes and ventricular pressure was monitored using di-8-ANEPPS staining of the t-tubule network in hearts ex vivo. Sp administration led to longer sarcomere lengths at each pressure indicative of improved ventricular compliance in WD-fed mice. Sp also prevented left ventricular hypertrophy, interstitial fibrosis, and oxidative stress. Sp prevented the WD-induced increased expression of myocardial proinflammatory M1 macrophage markers monocyte chemoattractant protein-1 and CD11c and increased the expression of the anti-inflammatory M2 macrophage marker CD206. These findings demonstrate that WD-induced DD is associated with increased oxidant stress, fibrosis, and immune dysregulation. Mineralocorticoid receptor antagonism enhanced M2 macrophage polarization and ameliorated oxidant stress and fibrosis. This work supports a novel blood pressure-independent effect of MR antagonism as a strategy to prevent diet-induced DD in women. Mineralocorticoid antagonism; low-dose spironolactone; aldosterone;high-fat diet; high-fructose diet; oxidative stress; inflammation; cardiac hypertrophy; myocardial compliance.
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Affiliation(s)
- Brian Bostick
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, Columbia, Missouri
| | - Javad Habibi
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Vincent G DeMarco
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Guanghong Jia
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Timothy L Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Michelle D Lambert
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri
| | - Annayya R Aroor
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Ravi Nistala
- Division of Nephrology, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Shawn B Bender
- Department of Biomedical Sciences, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and Dalton Cardiovascular Research Center, Columbia, Missouri
| | - Mona Garro
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Melvin R Hayden
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Lixin Ma
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - Camila Manrique
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and
| | - James R Sowers
- Division of Endocrinology, Diabetes and Metabolism, University of Missouri, Columbia, Missouri; Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, Missouri; Research Service, Harry S. Truman Memorial Veterans Hospital, Columbia, Missouri; and Dalton Cardiovascular Research Center, Columbia, Missouri Department of Radiology, University of Missouri, Columbia, Missouri;
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Di Chiara T, Argano C, Scaglione A, Duro G, Corrao S, Scaglione R, Licata G. Hypoadiponectinemia, cardiometabolic comorbidities and left ventricular hypertrophy. Intern Emerg Med 2015; 10:33-40. [PMID: 25034520 DOI: 10.1007/s11739-014-1104-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Abstract
This study was designed to evaluate the prevalence of cardiometabolic comorbidities and the changes in left ventricular geometry and function in 135 subjects subgrouped according to low or normal total adiponectin plasma (ADPN) levels. Left ventricular (LV) internal diameter/height, total LV mass (LVM) and LVM index (LVMI), relative wall thickness (RWT), LV ejection fraction by echocardiography and diastolic parameters by pulsed-wave Doppler were calculated. Body mass index (BMI) (p < 0.0001), waist-to-hip ratio (p < 0.03), triglycerides (p < 0,001), prevalence of obesity (p < 0.005), visceral obesity (p < 0.003), left ventricular hypertrophy (LVH) (p < 0.001), metabolic syndrome (p < 0.0003) and coronary artery disease (CAD) (p < 0.003) were significantly increased and high-density lipoprotein-cholesterol (p < 0.001) was significantly reduced in hypo-ADPN than normal-ADPN subjects. LVM, LVMI, interventricular septum thickness and RWT were significantly (p < 0.0001) higher and left ventricular ejection fraction was significantly (p < 0.0002) lower in hypo-ADPN than normal-ADPN patients. LVMI correlated directly with BMI (p < 0.001), mean blood pressure (p < 0.001), metabolic syndrome (MetS) (p < 0.001) and inversely with ADPN (p < 0.0001). The prevalence of LVH (p < 0.001) and CAD (p < 0.01) was higher in subjects with normal-ADPN and MetS, while the presence of MetS did not change this finding in hypo ADPN group. Both models of regression analysis indicated that ADPN and BMI resulted independently associated with LVMI. In conclusion, our data seem to indicate that hypoadiponectinemia might be associated with an increased prevalence both of clinical comorbidities and increased LVMI. In this subset of subjects, ADPN and BMI, more than MetS, are able to explain cardiac damage. Accordingly, ADPN might become a new target in the management of cardiometabolic risk.
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Affiliation(s)
- Tiziana Di Chiara
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
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Li H, Pei F, Shao L, Chen J, Sun K, Zhang X, Zhang C, Liu J, Xiao C, Hui R. Prevalence and risk factors of abnormal left ventricular geometrical patterns in untreated hypertensive patients. BMC Cardiovasc Disord 2014; 14:136. [PMID: 25280487 PMCID: PMC4192326 DOI: 10.1186/1471-2261-14-136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 09/29/2014] [Indexed: 01/11/2023] Open
Abstract
Background The various prevalence of LVH and abnormal LV geometry have been reported in different populations. So far, only a few reports are available on the prevalence of LV geometric patterns in a large Chinese untreated hypertensive population. Methods A total of 9,286 subjects (5167 men and 4119 women) completed the survey and 1641 untreated hypertensive patients (1044 males and 597 females) enrolled in the present study. The LV geometry was classified into four patterns: normal; abnormal,defined as concentric remodeling;concentric or eccentric hypertrophy based on the values of left ventricular mass index (LVMI) and relative wall thickness (RWT). Logistic regression model was applied to determine the odds ratio (OR) and 95% confidence intervals (CI) of the risk factors of left ventricular hypertrophy. Results The prevalence of LVH was 20.2% in untreated hypertensive patients, much higher in women (30.8%) than in men (14.2%) (P < 0.01). The prevalence of LV geometrical patterns was 34.9%, 11.1%, 9.1% for concentric remodeling, concentric and eccentric hypertrophy,respectively. After adjustment by using Logistic regression model, the risk factors for LVH and abnormal LV geometry were age, female, systolic blood pressure, and body mass index. And low high density lipoprotein maybe a positive factor. Conclusions The prevalence of LVH and abnormal LV geometric patterns was higher in women than in men and increased with age. It is crucial to improve the awareness rate of hypertension and control the risk factors of CV complications in untreated hypertensive population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chuanshi Xiao
- Department of Cardiology, The First Hospital Affiliated to Shanxi Medical University, 85 Jiefang South Road, Taiyuan City, Shanxi Province 030001, China.
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Catena C, Colussi G, Capobianco F, Brosolo G, Sechi LA. Uricaemia and left ventricular mass in hypertensive patients. Eur J Clin Invest 2014; 44:972-81. [PMID: 25186106 DOI: 10.1111/eci.12331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/29/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Both hyperuricaemia and left ventricular (LV) hypertrophy are associated with the metabolic syndrome and increased cardiovascular risk. The relationship between uric acid levels and left ventricular mass in hypertension, however, is unclear. In this study, we have investigated this relationship in hypertensive patients without the metabolic syndrome. MATERIALS AND METHODS In a cross-sectional study, 367 nondiabetic, essential hypertensive patients (age 52 ± 14; 194 males and 173 females) free of clinically relevant cardiovascular complications and without the metabolic syndrome were consecutively recruited at a university hypertension clinic. In these patients, we measured plasma levels of uric acid, lipids, glucose and insulin at fast and after an oral glucose load (OGTT), renal function and performed both conventional and tissue Doppler echocardiography. RESULTS Hypertensive patients with LV hypertrophy had higher uric acid levels and greater prevalence of hyperuricemia than patients with normal left ventricular mass. Uric acid levels were directly related with fasting and post-OGTT plasma insulin and with the HOMA index and inversely with 24-h creatinine clearance. Uric acid was also significantly and directly related with the left ventricular mass and multivariate regression analysis showed that this relationship was independent from components of the metabolic syndrome and renal function in women, but not in men. CONCLUSIONS Elevated uric acid levels are independently related to the left ventricular mass in hypertensive women without the metabolic syndrome. In these patients with a low cardiovascular risk profile, uric acid might contribute to the development of subclinical cardiac damage.
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Affiliation(s)
- Cristiana Catena
- Hypertension Unit, Division of Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
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Mulè G, Calcaterra I, Nardi E, Cerasola G, Cottone S. Metabolic syndrome in hypertensive patients: An unholy alliance. World J Cardiol 2014; 6:890-907. [PMID: 25276291 PMCID: PMC4176799 DOI: 10.4330/wjc.v6.i9.890] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 02/06/2023] Open
Abstract
For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes.
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Influence of metabolic syndrome and its components on subclinical organ damage in hypertensive perimenopausal women. Adv Med Sci 2014; 59:232-9. [PMID: 25051419 DOI: 10.1016/j.advms.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 12/11/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE We investigated the association between metabolic syndrome (MS), its components and the presence of subclinical organ damage in hypertensive perimenopausal women. PATIENTS/METHODS 152 women with newly diagnosed, untreated arterial hypertension (mean age 51.0 ± 3.5 years) were included in the study. In all subjects anthropometrical measurements, 24-hr blood pressure monitoring, echocardiographic examination, and carotid ultrasound were performed. Carotid-femoral pulse wave velocity (PWV) was measured to obtain data on vascular compliance. As the index of early kidney damage both glomerular filtration rate was calculated and albumin/creatinine ratio in the urine sample was measured. A fasting blood sample was taken to measure glucose and lipid concentration. RESULTS MS was found in 41% of patients. Patients with MS exhibited elevated left ventricular mass index (LVMI 84.7 vs. 78.8 g/m(2.7), p=0.03), higher intima-media thickness (IMT 0.67 vs. 0.62 mm, p=0.003), greater prevalence of LV hypertrophy (30% vs. 13%, p=0.01), and carotid plaques (24% vs. 15%, p=0.01). The multivariate regression analysis revealed that components of MS (systolic blood pressure and waist circumference) are stronger predictors of LVM than MS itself. The relationship between MS and LVMI lost its significance when BMI was included in the model, and remained significant for IMT. CONCLUSION In hypertensive perimenopausal women components of MS are stronger predictors of subclinical organ damage than MS itself. Left ventricular mass and hypertrophy are more strongly correlated with increasing body weight than with the presence of MS. MS, independently of BMI, influences the level of subclinical atherosclerosis in the study group.
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Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KYA, Peng J, Rasmussen-Torvik L, Sha J, Irvin MR, Gu CC, Lewis CE, Hunt SC, Arnett DK, Shah SJ. Association of comorbidity burden with abnormal cardiac mechanics: findings from the HyperGEN study. J Am Heart Assoc 2014; 3:e000631. [PMID: 24780206 PMCID: PMC4309045 DOI: 10.1161/jaha.113.000631] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Comorbidities are common in heart failure (HF), and the number of comorbidities has been associated with poor outcomes in HF patients. However, little is known about the effect of multiple comorbidities on cardiac mechanics, which could impact the pathogenesis of HF. We sought to determine the relationship between comorbidity burden and adverse cardiac mechanics. Methods and Results We performed speckle‐tracking analysis on echocardiograms from the HyperGEN study (n=2150). Global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities were measured. We evaluated the association between comorbidity number and cardiac mechanics using linear mixed effects models to account for relatedness among subjects. The mean age was 51±14 years, 58% were female, and 47% were African American. Dyslipidemia and hypertension were the most common comorbidities (61% and 58%, respectively). After adjusting for left ventricular (LV) mass index, ejection fraction, and several potential confounders, the number of comorbidities remained associated with all indices of cardiac mechanics except global circumferential strain (eg, β=−0.32 [95% CI −0.44, −0.20] per 1‐unit increase in number of comorbidities for global longitudinal strain; β=−0.16 [95% CI −0.20, −0.11] for e' velocity; P≤0.0001 for both comparisons). Results were similar after excluding participants with abnormal LV geometry (P<0.05 for all comparisons). Conclusions Higher comorbidity burden is associated with worse cardiac mechanics, even in the presence of normal LV geometry. The deleterious effect of multiple comorbidities on cardiac mechanics may explain both the high comorbidity burden and adverse outcomes in patients who ultimately develop HF.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Aksoy S, Durmuş G, Özcan S, Toprak E, Gurkan U, Oz D, Canga Y, Karatas B, Duman D. Is left ventricular diastolic dysfunction independent from presence of hypertension in metabolic syndrome? An echocardiographic study. J Cardiol 2014; 64:194-8. [PMID: 24525047 DOI: 10.1016/j.jjcc.2014.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND It has been shown that left ventricular diastolic dysfunction (LVDD) develops in patients with metabolic syndrome (MetS). However, there is not sufficient evidence in the literature to determine whether this condition is due to increase in blood pressure, which is frequently encountered in MetS. The purpose of this study was to test the hypothesis whether LVDD in MetS is independent from the presence of hypertension. METHODS A total of 60 patients diagnosed with MetS and 30 healthy people, who were age- and gender-matched with the patient group, were included in the study as the control group. In the study group, 30 of the patients were normotensive whereas the other 30 had hypertension. Conventional echocardiographic examinations and tissue Doppler imaging were performed besides measurements of demographic and biochemical parameters. RESULTS In the hypertensive MetS group, early diastolic filling flow (E), early diastolic mitral annular velocity (E'), and E/A ratio were significantly lower compared to the control group. Late diastolic filling flow (A), deceleration time (DT), late diastolic mitral annular velocity (A'), and E/E' ratio were higher in the hypertensive MetS group than the control group. In the normotensive MetS group, E, E', and E/A ratio were also lower compared to the control group whereas DT, A', and E/E' ratio were higher. CONCLUSION These findings support the idea that LVDD may develop in patients with MetS even in the absence of hypertension. In addition, co-existence of hypertension with MetS contributes to further worsening of diastolic functions.
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Affiliation(s)
- Sukru Aksoy
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Gündüz Durmuş
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Serhan Özcan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ercan Toprak
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ufuk Gurkan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Dilaver Oz
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Yigit Canga
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Baran Karatas
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Dursun Duman
- Medipol University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Ertürk M, Öner E, Kalkan AK, Püşüroğlu H, Özyılmaz S, Akgül Ö, Ünal Aksu H, Aktürk İF, Çelik Ö, Uslu N. The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in patient with metabolic syndrome. Anatol J Cardiol 2014; 15:42-9. [PMID: 25179884 PMCID: PMC5336897 DOI: 10.5152/akd.2014.5143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: The aim of this study was to assess subclinical left (LV) and right ventricular (RV) dysfunction novel load-independent isovolumic myocardial acceleration (IVA) derived from tissue Doppler imaging (TDI) in patient with metabolic syndrome (MetS). Methods: This study had an observational case-control design. The study included 133 subjects which were divided into two groups: 75 patients with MetS and 58 controls without MetS. MetS was defined by the presence of ≥3 criteria according to ATP-NCEP III guidelines. All the subjects underwent laboratory blood tests and complete conventional echocardiography and TDI. Student’s t, Mann-Whitney U, Pearson’s, and multiple regression analysis were used for statistical analysis. Results: There were no significant difference between two groups in terms of traditional echocardiographic parameters. The diastolic and global functions of both ventricles were significantly impaired in MetS group. The TDI-derived IVA of the LV and the RV was significantly lower in patients with MetS (3.2±0.9 vs. 4.0±1.4, p<0.001 and 2.6±0.7 vs. 3.1±0.9, p=0.001, respectively). Whereas, TDI derived systolic velocity (Sa), and peak myocardial velocity during isovolumic contraction (IVV) of both ventricles were similar between the two groups. In the multiple regression analysis, waist circumference and diastolic blood pressure were found to be an independent determinant of IVA of LV (β=-.223, 95% CI=-.034 -.002, p=0.004) and RV (β=-.527, 95% CI=-.085 -.020, p=0.002) respectively. Conclusion: MetS affects global, diastolic, and systolic functions of two ventricles. This disruption lead to decreased function of heart was related with raised risk factors of MetS
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Affiliation(s)
- Mehmet Ertürk
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul-Turkey.
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Fournier SB, Reger BL, Donley DA, Bonner DE, Warden BE, Gharib W, Failinger CF, Olfert MD, Frisbee JC, Olfert IM, Chantler PD. Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome. Exp Physiol 2014; 99:149-63. [PMID: 24036595 PMCID: PMC3947356 DOI: 10.1113/expphysiol.2013.075796] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.
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Affiliation(s)
- Sara B Fournier
- P. D. Chantler: West Virginia University, 1 Medical Center Drive, PO Box 9227, Morgantown, WV 26508, USA.
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28
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Evaluation of coronary artery disease and cardiac morphology and function in patients with hypertrophic cardiomyopathy, using cardiac computed tomography. Heart Vessels 2013; 30:28-35. [PMID: 24326884 DOI: 10.1007/s00380-013-0452-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/29/2013] [Indexed: 01/16/2023]
Abstract
Coronary artery disease and cardiac morphology and function were evaluated in 51 patients with hypertrophic cardiomyopathy (HCM), without typical chest pain, using cardiac computed tomography (CT). This study investigated the prevalence of coronary artery disease, the indicators of obstructive coronary stenosis, and the magnitude of left ventricular (LV) hypertrophy. The patients' mean coronary artery calcium score was 198.8 ± 312.0 and was positively correlated with the number of coronary risk factors (r = 0.32; P < 0.05). Of the 51 patients with HCM, 42 (82.4 %) had some degree of stenosis and 8 (15.7 %) had obstructive stenosis. Noncalcified and mixed plaques were detected in 14 (27.5 %) and 11 (21.6 %) patients, respectively. Multivariate logistic regression revealed that diabetes was an independent indicator of the presence of obstructive stenosis in HCM patients. Multivariate linear regression revealed that low estimated glomerular filtration rates and high triglyceride concentrations were independent indicators of higher LV mass indexes. In conclusion, cardiac CT revealed that coronary artery disease was common among patients with HCM. The presence of obstructive coronary stenosis and the magnitude of LV hypertrophy were related to the presence of diabetes, triglyceride levels, and estimated glomerular filtration rate.
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29
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Tadic MV, Ivanovic BA, Petrovic M, Celic V, Neskovic A. Gender influence on left ventricular structure and function in metabolic syndrome. Are women at greater risk? JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:538-545. [PMID: 23303723 DOI: 10.1002/jcu.22016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The aim of this study was to investigate the influence of metabolic syndrome (MS) on left ventricular (LV) structure and function depending on gender. METHODS The study included 235 never-treated MS subjects and 138 controls. MS was defined as the presence of three or more National Cholesterol Education Program's Adult Treatment Panel III criteria. All the subjects underwent laboratory blood tests and complete two-dimensional, pulsed, and tissue Doppler echocardiography. RESULTS LV structure, diastolic function, and global function were significantly impaired in all MS subjects. Multivariate analysis of individual MS factors showed that increased blood pressure (BP) and impaired fasting glucose were independently associated with LV hypertrophy in women, whereas the only independent predictor in men was increased BP. The same analysis revealed that the combination of impaired glucose level, abdominal obesity, and dyslipidemia was associated with LV hypertrophy only in women. Higher BP, impaired fasting glucose, and triglycerides level were independently associated with LV diastolic dysfunction in women, whereas higher BP was the only independent predictor in men. The combination of increased BP, fasting glucose, and dyslipidemia was independently associated with LV diastolic dysfunction only in women. CONCLUSIONS Different MS factors are responsible for LV remodeling in women and men. The metabolic sequence of MS is more important for LV remodeling in women.
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Affiliation(s)
- Marijana V Tadic
- Clinical Centre of Serbia, Clinic for Cardiology, Koste Todorovic 8, 11000 Belgrade, Serbia
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30
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Manrique C, DeMarco VG, Aroor AR, Mugerfeld I, Garro M, Habibi J, Hayden MR, Sowers JR. Obesity and insulin resistance induce early development of diastolic dysfunction in young female mice fed a Western diet. Endocrinology 2013; 154:3632-42. [PMID: 23885014 PMCID: PMC5398539 DOI: 10.1210/en.2013-1256] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/16/2013] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD), including heart failure, constitutes the main source of morbidity and mortality in men and women with diabetes. Although healthy young women are protected against CVD, postmenopausal and diabetic women lose this CVD protection. Obesity, insulin resistance, and diabetes promote heart failure in females, and diastolic dysfunction is the earliest manifestation of this heart failure. To examine the mechanisms promoting diastolic dysfunction in insulin-resistant females, this investigation evaluated the impact of 8 weeks of a high-fructose/high-fat Western diet (WD) on insulin sensitivity and cardiac structure and function in young C57BL6/J female versus male mice. Insulin sensitivity was determined by hyperinsulinemic-euglycemic clamps and two-dimensional echocardiograms were used to evaluate cardiac function. Both males and females developed systemic insulin resistance after 8 weeks of a WD. However, only the females developed diastolic dysfunction. The diastolic dysfunction promoted by the WD was accompanied by increases in collagen 1, a marker of stiffness, increased oxidative stress, reduced insulin metabolic signaling, and increased mitochondria and cardiac microvascular alterations as determined by electron microscopy. Aldosterone (a promoter of cardiac stiffness) levels were higher in females compared with males but were not affected by the WD in either gender. These data suggest a predisposition toward developing early diastolic heart failure in females exposed to a WD. These data are consistent with the notion that higher aldosterone levels, in concert with insulin resistance, may promote myocardial stiffness and diastolic dysfunction in response to overnutrition in females.
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Affiliation(s)
- Camila Manrique
- MD, Professor of Medicine and Medical Pharmacology and Physiology, University of Missouri, D109 Diabetes Center Health Sciences Center, One Hospital Drive, Columbia, Missouri 65212.
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31
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Nicolini E, Martegani G, Maresca AM, Marchesi C, Dentali F, Lazzarini A, Speroni S, Guasti L, Bertolini A, Venco A, Grandi AM. Left ventricular remodeling in patients with metabolic syndrome: influence of gender. Nutr Metab Cardiovasc Dis 2013; 23:771-775. [PMID: 22770750 DOI: 10.1016/j.numecd.2012.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/12/2012] [Indexed: 12/28/2022]
Abstract
AIM The study was aimed to evaluate the influence of gender on left ventricular (LV) remodeling in metabolic syndrome (MetS). METHODS AND RESULTS We enrolled 200 subjects without diabetes or overt cardiovascular diseases, never treated with anti-hypertensive drugs or statins: 60 men and 40 women with MetS matched by age, gender and 24 h systolic and diastolic blood pressure (BP) with 60 men and 40 women without MetS. The patients underwent blood tests, 24 h our BP monitoring, LV echocardiographic examination. LV mass indexed by eight(2.7) was significantly greater in men and women with MetS than without MetS. Compared with women without MetS, women with MetS had significantly higher posterior wall thickness and relative wall thickness, greater prevalence of LV concentric remodeling/hypertrophy and lower indices of LV diastolic function, whereas all these parameters were not significantly different between men with and without MetS. MetS was an independent predictor of relative wall thickness and LV mass index in women, but not in men. CONCLUSION The impact of MetS on LV remodeling is significantly influenced by gender: the effects of MetS are more pronounced in women, with development of LV concentric hypertrophy/remodeling and preclinical diastolic dysfunction.
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Affiliation(s)
- E Nicolini
- Ospedale di Circolo-Fondazione Macchi, Varese, Italy.
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Hoebel S, Malan L, De Ridder JH. Determining ethnic-, gender-, and age-specific waist circumference cut-off points to predict metabolic syndrome: the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2013. [DOI: 10.1080/22201009.2013.10872311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Hoebel
- Physical Activity Sport and Recreation, School of Biokinetics, Recreation and Sport Science North-West University, Potchefstroom Campus
| | - L Malan
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences North-West University, Potchefstroom Campus
| | - JH De Ridder
- Physical Activity Sport and Recreation, School of Biokinetics, Recreation and Sport Science North-West University, Potchefstroom Campus
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Capaldo B, Di Bonito P, Iaccarino M, Roman MJ, Lee ET, Devereux RB, Riccardi G, Howard BV, de Simone G. Cardiovascular characteristics in subjects with increasing levels of abnormal glucose regulation: the Strong Heart Study. Diabetes Care 2013; 36:992-7. [PMID: 23223343 PMCID: PMC3609517 DOI: 10.2337/dc12-1501] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether impaired fasting glucose (IFG) or the combination of IFG and impaired glucose tolerance (IGT) is associated with progressive abnormalities of cardiac geometry and function. RESEARCH DESIGN AND METHODS We studied 562 nondiabetic (311 women), nonhypertensive participants of the second Strong Heart Study exam, without prevalent cardiovascular (CV) disease and with estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) (age 46-65 years, 198 with isolated IFG [35%], and 132 with combined IFG and IGT [23%]). Anthropometric parameters, insulin resistance, fibrinogen, C-reactive protein (CRP), lipid profile, blood pressure (BP), and echocardiographic parameters were compared with 232 participants with normal glucose tolerance (NGT). RESULTS BMI, prevalence of central obesity, homeostatic model assessment index of insulin resistance, plasma triglycerides, fibrinogen, and CRP increased progressively across categories of glucose intolerance (P < 0.0001), with the IFG+IGT group having higher values than those with isolated IFG (0.05 < P < 0.0001). Compared with NGT, both IFG and IFG+IGT exhibited greater left ventricular (LV) mass (P < 0.0001) and lower Doppler early peak rapid filling velocity to peak atrial filling velocity ratio (P < 0.005), without differences in LV systolic function. The odds of LV hypertrophy (LV mass index >46.7 in women or >49.2 g/m(2.7) in men) was 3.5 in IFG participants (95% CI 0.68-17.76; P = NS) and 9.76 (2.03-46.79; P = 0.004) in IFG+IGT, compared with NGT, after adjustment for age, sex, heart rate, systolic BP, and waist circumference (WC). In the overall sample, LV mass index was associated with WC (P = 0.033), CRP (P = 0.027), and 2-h oral glucose tolerance test (P = 0.001) independently of confounders. CONCLUSIONS Cardiometabolic profile and markers of inflammation are more severely altered in men and women with both IFG and IGT compared with those with IFG alone. These individuals, in the absence of hypertension, have a 10-fold greater probability of preclinical CV disease (LV hypertrophy).
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Affiliation(s)
- Brunella Capaldo
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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Hermida RC, Smolensky MH, Ayala DE, Portaluppi F, Crespo JJ, Fabbian F, Haus E, Manfredini R, Mojón A, Moyá A, Piñeiro L, Ríos MT, Otero A, Balan H, Fernández JR. 2013 Ambulatory Blood Pressure Monitoring Recommendations for the Diagnosis of Adult Hypertension, Assessment of Cardiovascular and other Hypertension-associated Risk, and Attainment of Therapeutic Goals. Chronobiol Int 2013; 30:355-410. [DOI: 10.3109/07420528.2013.750490] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eglit T, Lember M, Ringmets I, Rajasalu T. Gender differences in serum high-molecular-weight adiponectin levels in metabolic syndrome. Eur J Endocrinol 2013; 168:385-91. [PMID: 23230211 DOI: 10.1530/eje-12-0688] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study was to estimate gender-specific associations between metabolic syndrome (MS) and high-molecular-weight (HMW) adiponectin in an Estonian adult population. METHODS Plasma HMW adiponectin was measured in 458 subjects (191 men) who participated in a population-based cross-sectional multicenter study (n=495) on the prevalence of metabolic disorders in Estonia. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS Median HMW adiponectin levels (μg/ml) were significantly lower among all subjects with MS compared with subjects without MS: 2.1 vs 2.8 in men (P=0.002) and 3.1 vs 5.1 in women (P<0.001). In a fully adjusted, logistic regression model containing HMW adiponectin, homeostasis model assessment of insulin resistance (HOMA-IR), BMI, and age, HMW adiponectin was significantly associated with MS only in women. Comparison of HMW adiponectin and HOMA-IR as markers for MS indicated that HOMA-IR predicted MS better than did HMW adiponectin in both genders. However, after adjusting for age and BMI, HOMA-IR was a significantly better predictor only in men. HMW adiponectin and HOMA-IR predicted the presence of MS at the same level in women. Areas under the receiver operating characteristic curves for HMW adiponectin and HOMA-IR were 0.833 vs 0.88 in men (P=0.02) and 0.897 vs 0.907 in women (P=0.5). CONCLUSIONS These data suggest that the association between low HMW adiponectin levels and presence of MS might be stronger in women compared with men.
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Affiliation(s)
- Triin Eglit
- Departments of Internal Medicine, University of Tartu, 6 L. Puusepa Street, 51014 Tartu, Estonia.
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Tadic MV, Ivanovic BA, Petrovic M. Is Gender Responsible for Everything? The Relationship between Sex and Right Ventricular Remodeling in Metabolic Syndrome. Echocardiography 2013; 30:778-85. [DOI: 10.1111/echo.12135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cuspidi C, Sala C, Lonati L, Negri F, Rescaldani M, Re A, Meani S, Mancia G. Metabolic syndrome, left ventricular hypertrophy and carotid atherosclerosis in hypertension: a gender-based study. Blood Press 2012. [PMID: 23181484 DOI: 10.3109/08037051.2012.744151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of gender on the association between metabolic syndrome (MS) and subclinical organ damage (OD) has been poorly investigated. The aim of this study was to investigate whether the risk of developing left ventricular hypertrophy (LVH) and carotid atherosclerosis is different in men and women with MS. METHODS A total of 3752 untreated and treated hypertensive patients (mean age 53.3 ± 12.6, 52.7% men) were considered for this analysis. All patients underwent standard ultrasonographic investigations searching for LVH and carotid atherosclerosis. The MS was defined according to ATP III criteria. RESULTS LVH was more prevalent in women and men with the MS compared with their counterparts (58% vs 34% and 48% vs 33%, respectively, p < 0.001). This was also the case for carotid plaque prevalence (61% vs 42% and 57% vs 44%, p < 0.001). The prevalence of OD was not different between men and women with MS, after adjusting for confounders. In multivariate analysis, abdominal obesity was the most important MS component independently related to LVH in both genders, followed by blood pressure. As for carotid plaques, blood pressure, hyperglycemia and hypertriglyceridemia turned out to be independent correlates regardless of gender. CONCLUSIONS Our data indicate that MS is associated with a higher risk of LVH and carotid atherosclerosis irrespective of gender; these findings do not support a gender influence in the association between MS and subclinical OD.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.
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Ahonen T, Vanhala M, Kautiainen H, Kumpusalo E, Saltevo J. Sex differences in the association of adiponectin and low-grade inflammation with changes in the body mass index from youth to middle age. ACTA ACUST UNITED AC 2012; 9:1-8. [PMID: 22333520 DOI: 10.1016/j.genm.2012.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/10/2011] [Accepted: 01/02/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are sex differences in low-grade inflammation markers in obesity-related disorders. Little is known, however, about a possible sex-specific association of relative weight change from youth to adulthood with actual low-grade inflammation. OBJECTIVE The aim of this study was to identify possible sex differences in adiponectin, interleukin-1β (IL-1β), interleukin-1Ra (IL-1Ra), and high-sensitivity C-reactive protein (hs-CRP) levels with respect to the relative change in body mass index (BMI) from youth to middle age. METHODS The study population consisted of 403 men and 500 women from 1 Finnish town. Weight, height, and adiponectin, IL-1β, IL-1Ra, and hs-CRP levels were measured in 2003 at a mean age of 46 years. Self-reported weight at the age of 20 years was recorded. RESULTS In women, even after adjustment for BMI in adulthood, a statistically significantly negative linear association was observed between the quartiles of relative change in BMI and adiponectin levels (P < 0.001 for linearity). Significantly positive linear associations were also observed between the change in BMI and IL-1Ra (P = 0.032 for linearity) and hs-CRP (P = 0.029 for linearity) levels. In men, there was no statistically significant association among the quartiles of relative change in BMI and measured inflammatory markers after adjustment for BMI in adulthood. CONCLUSIONS A relative increase in weight may be more harmful in women than in men with respect to adiponectin and inflammatory markers.
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Affiliation(s)
- Tiina Ahonen
- Central Finland Regional Health Centre, Jyväskylä, Finland.
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40
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Bacharova L, Krivosikova Z, Wsolova L, Gajdos M. Alterations in the QRS complex in the offspring of patients with metabolic syndrome and diabetes mellitus: early evidence of cardiovascular pathology. J Electrocardiol 2012; 45:244-51. [PMID: 22520960 DOI: 10.1016/j.jelectrocard.2012.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the nature and onset of changes in the QRS complex in the offspring of patients with diabetes mellitus (DM) and metabolic syndrome (MetS). METHODS AND METHODS A total of 529 subjects, divided into 5 groups, were included in the study: (i) group DM (n = 92), patients with DM; (ii) group MetS (n = 125), patients with MetS; (iii) group O-DM (n = 109), offspring of patients with DM; (iv) group O-MetS (n = 122), offspring of patients with MetS; and (v) group HO (n = 81), offspring of healthy subjects. QRS parameters analyzed included amplitude, maximum QRS spatial vector magnitude, electrical axis (EA), and 3 electrocardiogram (ECG) criteria for left ventricular hypertrophy based on amplitude criteria: Sokolow-Lyon index, Cornell voltage, and Gubner criterion. RESULTS Patients with DM and MetS showed a significant leftward shift of the EA when compared with the control group. A modest but significant leftward shift of EA was also observed in both offspring groups. These EA and maximum QRS spatial vector magnitude changes were reflected in the individual leads of the 12-lead ECG. The prevalence of a positive diagnosis by accepted electrocardiographic criteria (ECG left ventricular hypertrophy) was low. CONCLUSION Patients with DM and MetS displayed significant changes in QRS complex that suggest depolarization sequence deterioration. Similar changes were observed also in the offspring of patients with DM and MetS, which suggests early subclinical cardiovascular damage. These findings have implications for prevention, early diagnosis, and treatment in the offspring of patients with DM and MetS.
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Sarzani R, Guerra F. Obesity and Hypertension in Cardiac Hypertrophy. High Blood Press Cardiovasc Prev 2012; 19:3-4. [DOI: 10.2165/11632080-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Halldin M, Fahlstadius P, de Faire U, Vikström M, Hellénius ML. The metabolic syndrome and left ventricular hypertrophy – the influence of gender and physical activity. Blood Press 2011; 21:153-60. [DOI: 10.3109/08037051.2012.641267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens 2011; 26:343-9. [PMID: 22113443 DOI: 10.1038/jhh.2011.104] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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, P<0.05); 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.
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Sex differences in obesity-related changes in left ventricular morphology: the Strong Heart Study. J Hypertens 2011; 29:1431-8. [PMID: 21558955 DOI: 10.1097/hjh.0b013e328347a093] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES It is unclear whether there are sex differences in the relations of left ventricular mass to body composition and fat distribution in nonobese or obese hypertensive and nonhypertensive individuals and whether the obesity-related increase in left ventricular mass is similar in men and women. METHODS We examined sex differences in the relations between left ventricular mass and both body composition and fat distribution, in the presence or absence of obesity in 1068 men and 1851 women (65%) of the Strong Heart Study cohort, without prevalent cardiovascular disease or severe chronic kidney disease. Fat-free mass (FFM) and adipose mass were estimated by bioelectric impedance analysis and fat distribution by waist-to-hip ratio (WHR). RESULTS Adipose mass was significantly higher in women than in men for any weight category (P < 0.0001). After adjusting for age, hypertension, systolic blood pressure (BP) and diabetes, both left ventricular mass/height (LVMi) and left ventricular mass (LVM)/FFM were greater in obese women than obese men (P < 0.0001). Relative wall thickness was also greater in women than in men (P < 0.0001). LVM was independently related to Doppler-stroke volume, FFM and systolic BP in both sexes, with WHR and adipose mass contributing to variance of LVM in women but not in men (both P < 0.03). CONCLUSION Obesity influences left ventricular geometry substantially more in women than in men, possibly due to biological factors specifically associated with female adiposity.
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Hermida RC, Chayán L, Ayala DE, Mojón A, Fontao MJ, Fernández JR. Relationship Between Metabolic Syndrome, Circadian Treatment Time, and Blood Pressure Non-Dipping Profile in Essential Hypertension. Chronobiol Int 2011; 28:509-19. [DOI: 10.3109/07420528.2011.580871] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ramón C. Hermida
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario,
Vigo, Spain
| | - Luisa Chayán
- Urgencias Sanitarias 061 Galicia, Servicio Gallego de Salud, Santiago de Compostela, Spain
| | - Diana E. Ayala
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario,
Vigo, Spain
| | - Artemio Mojón
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario,
Vigo, Spain
| | - María J. Fontao
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario,
Vigo, Spain
| | - José R. Fernández
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario,
Vigo, Spain
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Piñol C, Alegría E, Langham S. Carga epidemiológica y económica de la hipertensión arterial en pacientes con síndrome metabólico en España: un modelo basado en la prevalencia. HIPERTENSION Y RIESGO VASCULAR 2011. [DOI: 10.1016/j.hipert.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sliem H, Nasr G, Ibrahiem D. Global left ventricular performance in non-diabetic non-hypertensive metabolic syndrome adults. World J Cardiol 2011; 3:48-53. [PMID: 21390196 PMCID: PMC3051148 DOI: 10.4330/wjc.v3.i2.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/10/2010] [Accepted: 10/16/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the left ventricular structure and function in isolated metabolic syndrome. METHODS One hundred and fifty six consecutive adults with metabolic syndrome were enrolled in the study. Fifty nine had isolated metabolic syndrome (group A) and 97 had metabolic syndrome with hypertension and/or diabetes (group B). There was a control group of 34 healthy adults. In addition to classic echocardiographic assessment of myocardial structural and functional changes, the Tei index was used to evaluate global left ventricular performance. RESULTS There were no statistically significant differences between group A and controls in all parameters of left ventricular structural, systolic, and diastolic function except global myocardial performance (Tei index). On the other hand, significant differences were observed between group B and the control group in most of the parameters of left ventricular structural and global performance. CONCLUSION The early identification of isolated metabolic syndrome in non-diabetic, non-hypertensive adults may be an indication that aggressive preventive measures should not be postponed until overt obesity, hypertension or diabetes mellitus has developed.
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Affiliation(s)
- Hamdy Sliem
- Hamdy Sliem, Department of Internal Medicine, Faculty of Medicine, Suez Canal University, 41522 Ismailia, Egypt
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de las Fuentes L, de Simone G, Arnett DK, Dávila-Román VG. Molecular determinants of the cardiometabolic phenotype. Endocr Metab Immune Disord Drug Targets 2011; 10:109-23. [PMID: 20384572 DOI: 10.2174/187153010791213119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 04/04/2010] [Indexed: 12/25/2022]
Abstract
The metabolic syndrome represents a clustering of risk factors that has been shown to predict adverse cardiovascular outcomes. Although the precise mechanisms contributing to the cardiometabolic syndrome (CMS) remain poorly defined, accumulating evidence identifies two intersecting candidate pathways responsible for inflammation and energy homeostasis in the pathophysiology that underlie cardiometabolic traits. Although currently no pharmacologic interventions specifically target CMS, future drug development efforts should attempt to capitalize on molecular nodes at the intersections of these pathways in the CMS.
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Affiliation(s)
- Lisa de las Fuentes
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Guerra F, Mancinelli L, Angelini L, Fortunati M, Rappelli A, Dessì-Fulgheri P, Sarzani R. The association of left ventricular hypertrophy with metabolic syndrome is dependent on body mass index in hypertensive overweight or obese patients. PLoS One 2011; 6:e16630. [PMID: 21304952 PMCID: PMC3031611 DOI: 10.1371/journal.pone.0016630] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 12/26/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Overweight (Ow) and obesity (Ob) influence blood pressure (BP) and left ventricular hypertrophy (LVH). It is unclear whether the presence of metabolic syndrome (MetS) independently affects echocardiographic parameters in hypertension. METHODS 380 Ow/Ob essential hypertensive patients (age ≤ 65 years) presenting for referred BP control-related problems. MetS was defined according to NCEP III/ATP with AHA modifications and LVH as LVM/h(2.7) ≥ 49.2 g/m(2.7) in males and ≥ 46.7 g/m(2.7) in females. Treatment intensity score (TIS) was used to control for BP treatment as previously reported. RESULTS Hypertensive patients with MetS had significantly higher BMI, systolic and mean BP, interventricular septum and relative wall thickness and lower ejection fraction than those without MetS. LVM/h(2.7) was significantly higher in MetS patients (59.14 ± 14.97 vs. 55.33 ± 14.69 g/m(2.7); p = 0.022). Hypertensive patients with MetS had a 2.3-fold higher risk to have LVH/h(2.7) after adjustment for age, SBP and TIS (OR 2.34; 95%CI 1.40-3.92; p = 0.001), but MetS lost its independent relationship with LVH when BMI was included in the model. CONCLUSIONS In Ow/Ob hypertensive patients MetS maintains its role of risk factor for LVH independently of age, SBP, and TIS, resulting in a useful predictor of target organ damage in clinical practice. However, MetS loses its independent relationship when BMI is taken into account, suggesting that the effects on MetS on LV parameters are mainly driven by the degree of adiposity.
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Affiliation(s)
- Federico Guerra
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Lucia Mancinelli
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Luca Angelini
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Marco Fortunati
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Alessandro Rappelli
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Paolo Dessì-Fulgheri
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
| | - Riccardo Sarzani
- Department of Internal Medicine and Cardiovascular Diseases, “Hypertension Excellence Centre” of the European Society of Hypertension, University Hospital “Ospedali Riuniti,” University “Politecnica delle Marche,” Ancona, Italy
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Scholze J, Alegria E, Ferri C, Langham S, Stevens W, Jeffries D, Uhl-Hochgraeber K. Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model. BMC Public Health 2010; 10:529. [PMID: 20813031 PMCID: PMC2940918 DOI: 10.1186/1471-2458-10-529] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 09/02/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the epidemiological and economic burden to the health service of metabolic syndrome in patients with hypertension in three European countries in 2008 and 2020. METHODS An age, sex and risk group structured prevalence based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define metabolic syndrome. Data sources included published information and public use databases on disease prevalence, incidence of cardiovascular events, prevalence of type 2 diabetes, treatment patterns and cost of management in Germany, Spain and Italy. RESULTS The prevalence of hypertension with metabolic syndrome in the general population of Germany, Spain and Italy was 36%, 11% and 10% respectively. In subjects with hypertension 61%, 22% and 21% also had metabolic syndrome. Incident cardiovascular events and attributable mortality were around two fold higher in subjects with metabolic syndrome and prevalence of type 2 diabetes was around six-fold higher. The economic burden to the health service of metabolic syndrome in patients with hypertension was been estimated at €24,427, €1,900 and €4,877 million in Germany, Spain and Italy and forecast to rise by 59%, 179% and 157% respectively by 2020. The largest components of costs included the management of prevalent type 2 diabetes and incident cardiovascular events. Mean annual costs per hypertensive patient were around three-fold higher in subjects with metabolic syndrome compared to those without and rose incrementally with the additional number of metabolic syndrome components present. CONCLUSION The presence of metabolic syndrome in patients with hypertension significantly inflates economic burden and costs are likely to increase in the future due to an aging population and an increase in the prevalence of components of metabolic syndrome.
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Affiliation(s)
- Jürgen Scholze
- Department of Medicine, Outpatient Clinic, CCM, Charite-Universitatsmedizin Berlin, Luisenstrasse 11-13, 10117 Berlin, Germany.
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