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Aims: To investigate if community detected Metabolic Syndrome (MetS) is associated with the burden of incipient HFpEF in the community. Methods and Results: We prospectively studied 148 consecutive MetS patients identified from the Lithuanian High Cardiovascular Risk primary prevention programme and investigated them further for unknown HFpEF through cardiopulmonary stress testing as well as assessment of BNP levels and of arterial stiffness. Subjects with a peak VO2 value lower than 90% of predicted and/or BNP≥35 ng/l were categorized as having early phase HFpEF. For comparison of this early phase HFpEF with others already clinically diagnosed with HFpEF, patients with both established HFpEF and MetS were selected retrospectively from patients attending our cardiopulmonary stress testing laboratory (n=38). Two thirds of the screening programme-derived MetS population (n=96) demonstrated a reduced exercise capacity and/or an elevated BNP, indicating signs of early HFpEF. Both the clinically diagnosed HFpEF and the screening programme detected MetS group with early HFpEF demonstrated similarly decreased exercise tolerance evaluated by peak oxygen uptake (79.8 ± 22.1% vs 82.7 ± 14.0%, p>0.05). Analysis of arterial markers in the screening programme group revealed statistically significant differences of augmentation index values between groups with and without signs of early HFpEF (p=0.016).Conclusion: A considerable proportion of patients having MetS may be diagnosed with previously undetected early stage HFpEF. The use of objective parameters of exercise capacity and neurohormonal activation might be effectively used for the early detection of HFpEF. Also early HFpEF in this setting is found to be associated with increased arterial stiffness.

SummaryObjectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects.Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training.Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m 2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034).Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.