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Association of left ventricular hypertrophy with metabolic risk factors: the HyperGEN study
Giovanni de Simone1, Vittorio Palmieri, Jonathan N Bella
1Department of Medicine, The New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA. simogi@unina.it
Insights
Metabolic risk factors like obesity, diabetes, and high cholesterol increase left ventricular (LV) mass, particularly when combined. This highlights LV mass as a key indicator for cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- Metabolic Syndrome
- Hypertension Research
Background:
- Metabolic risk factors such as obesity, diabetes, and hypercholesterolemia are prevalent in hypertensive populations.
- The combined impact of these metabolic factors on cardiac structure, specifically left ventricular (LV) mass and hypertrophy, requires further investigation.
Purpose of the Study:
- To investigate the influence of combined metabolic risk factors (obesity, diabetes, hypercholesterolemia) on left ventricular (LV) mass and the prevalence of LV hypertrophy.
- To assess whether the number of metabolic risk factors correlates with changes in LV mass and arterial compliance.
Main Methods:
- Cross-sectional study of 1627 hypertensive and 342 normotensive participants from the HyperGEN Study.
- Echocardiographic LV mass, normalized by height(2.7), was analyzed in relation to obesity (BMI, waist circumference), diabetes, and hypercholesterolemia.
- Stroke volume to pulse pressure ratio was assessed as a proxy for arterial compliance.
Main Results:
- LV mass/height(2.7) increased significantly with the number of metabolic risk factors in both hypertensive and normotensive individuals, independent of blood pressure.
- The prevalence of LV hypertrophy was independently associated with an increasing number of metabolic risk factors.
- Arterial compliance, estimated by stroke volume/pulse pressure, decreased with more metabolic risk factors, especially in hypertensive subjects.
Conclusions:
- Progressive accumulation of metabolic risk factors, including central obesity, diabetes, and hypercholesterolemia, is linked to increased LV mass, irrespective of hypertension.
- Obesity plays a significant role in this association, underscoring its impact on cardiac remodeling.
- LV mass serves as a valuable biomarker for assessing the effectiveness of global cardiovascular prevention strategies.
Objective:
To determine whether combinations of metabolic risk factors (obesity, diabetes and hypercholesterolemia) influence the magnitude of left ventricular (LV) mass and prevalence of LV hypertrophy.
Design:
Cross-sectional, relational.
Methods:
A total of 1627 hypertensive (85.9% treated, 1036 women, 1041 African Americans) and 342 normotensive (180 women, 183 African Americans) participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study, without prevalent cardiovascular disease, were studied. Echocardiographic LV mass, normalized by height(2.7) or fat-free mass or body surface area (BSA) and the ratio of stroke volume to pulse pressure as a percentage of predicted (as a crude estimate of arterial compliance) were analyzed in relation to obesity [by body mass index (BMI)], central fat distribution (by waist circumference), diabetes (by ADA criteria) and hypercholesterolemia.
Results:
Obesity, hypercholesterolemia, and diabetes were more frequent among hypertensives than normotensives (all P < 0.001). After controlling for age, sex, race and type and combination of antihypertensive medication, LV mass/height(2.7), but not LV mass/fat-free mass and LV mass/BSA, increased with the number of metabolic risk factors, both in normotensive and hypertensive participants, also after further adjustment for blood pressure (all P < 0.001). Stroke volume/pulse pressure also decreased in hypertensive, but much less in normotensive subjects, with increasing number of metabolic risk factors, independently of relevant confounders (P < 0.0001). Prevalence of LV hypertrophy was predicted by older age, hypertension, central fat distribution, black race and independently increased with the number of associated metabolic risk factors (P < 0.0001).
Conclusions:
The progressive addition of metabolic risk factors including central obesity, diabetes and hypercholesterolemia is associated with higher LV mass normalized by height(2.7), independently of hypertension and other important biological covariates. Obesity played a major role in this association. This finding indicates that LV mass is a potentially useful bioassay of strategies of global cardiovascular prevention.