Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study

Abstract

The relation of metabolic syndrome (MetS) with cardiovascular outcome may be less evident when preclinical cardiovascular disease is present. We explored, in a post hoc analysis, whether MetS predicts cardiovascular events in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. MetS was defined by X2 risk factors plus hypertension: body mass index X30 kg/m 2 , high-density lipoprotein (HDL)-cholesterol o1.0/1.3 mmol/l (o40/ 50 mg/dl) (men/women), glucose X6.1 mmol/l (X110 mg/ dl) fasting or X7.8 mmol/l (X140 mg/dl) nonfasting or diabetes. Cardiovascular death and the primary composite end point (CEP) of cardiovascular death, stroke and myocardial infarction were examined. In MetS (1591 (19.3%) of 8243 eligible patients), low HDL-cholesterol (72%), obesity (77%) and impaired glucose (73%) were similarly prevalent, with higher blood pressure, serum creatinine and Cornell product, but lower Sokolow-Lyon voltage (all Po0.001). After adjusting for baseline covariates, hazard ratios for CEPs and cardiovascular death (4.871.1 years follow-up) were 1.47 (95% confidence interval (CI), 1.27-1.71)-and 1.73 (95% CI, 1.38-2.17)-fold higher with MetS (both Po0.0001), and were only marginally reduced when further adjusted for diabetes, obesity, low HDL-cholesterol, non-HDL-cholesterol, pulse pressure and in-treatment systolic blood pressure and heart rate. Thus, MetS is associated with increased cardiovascular events in hypertensive patients with ECG-LVH, independently of single cardiovascular risk factors.

Hypertensive target organ damage predicts incident diabetes mellitus

“…This finding is consistent with the evidence that MetS significantly increases CV risk, independently of the effect of its single components. 15 Similar to what has been already suggested regarding the temporal relation between hypertension and LV hypertrophy, 21,22 our results indicate that the traditional assumption that diabetes precedes preclinical CVD might be revised. 2,3 In particular, diabetes is reported to be associated with greater LV mass, more concentric LV geometry, and lower myocardial function.…”

“…Metabolic syndrome (MetS) was defined according to modified ATPIII criteria, 13 changing waist circumference with BMI ≥30 kg/m 2 , as previously done when waist girth was not available. 14,15 Fasting glucose and lipid profile were measured by standard methods. Systolic and diastolic BP were measured by standard aneroid sphygmomanometer after 5 min rest in the supine position, according to current guidelines.…”

Prevalence of cardiovascular risk factors clustering among suburban residents in Beijing, China

“…The widely recognized need to manage global cardiovascular risk has recently been reinforced by studies examining the effect of cluster of CRFs [7]. Despite of the attention to major impact on cardiovascular risk, there was emerging evidence that the cluster of CRFs is more associated with preclinical CVD and higher rates of cardiovascular events [8,9].…”

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

“…[2][3][4][5][6][7][8][9][10][11][12] In some studies the CV morbidity and mortality risk associated with MetS has been examined separately in men and women and sometimes the prognostic impact of MetS was found to be higher in the female sex. 3,4 The development of asymptomatic structural and functional abnormalities at cardiac level in hypertensive patients with MetS may partially explain the occurrence of CV complications in this population.…”