Left ventricular hypertrophy and coronary heart disease in patients with metabolic syndrome and arterial hypertension.

Hippokratia 2004, 8(2):69-72

S Voyaki, A Efstratopoulos, T Gialernios, A Hatzis, A Baltas, L Mourgos, S Siasiakou, V Lekakis
Hypertension Unit & 3rd Medical Dpt of General Hospital of Athens, Athens, Greece


Background: Metabolic syndrome is considered as a situation associated with cardiovascular complications, obesity, hypertension and diabetes. Aim of the present study was the investigation of the prevalence of cardiac complications in patients suffering from metabolic syndrome (MS) and hypertension.
Methods: Patients with a follow up in our Hypertension Unit, with hypertension and fulfilling at least 3 of the 5 risk criteria of NCEP / ATP-III, namely: abdominal obesity (waist circumference of > 102 cm for men, and > 88 cm in women), triglycerides > 150 mg/dl, HDL-C < 40 mg/dl for men and < 50 mg/dl in women, blood pressure > 130/85 mmHg, and fasting glucose >110 mg/ dl, were included in the study. All patients were evaluated by recording past history for coronary heart disease (CHD), office and home blood pressure as well as 24-h-ABPM, ECG, M-Mode echocardiography and fasting plasma glucose to insulin ratio (FPG/FPI). No one patient was under antihypertensive or antilipidemic therapy. As left ventricular hyperrophy (LVH) characterized a left ventricular mass index (LVMI) of >125 gm/m2 for men and > 110 gm/m2 for women, using the criteria of Penn convention.
Results: From the 143 studied patients ( 82 M/ 61 F, aged 17-81 years), 11 patients (5%) had CHD and 65 (45.5%) LVH. The left ventricular wall thickness (LVWT) was found to be significantly related to pulse pressure (p<0.003) and significantly inversely related to FPG/FPI ratio (insulin sensitivity index). Multiple regression analysis with these relationships together and confounding factors age, sex, BMI waist, and duration of hypertension as independent variables showed FPI to be the only significant variable explaining 41% of the variation in LVWT, while duration of hypertension was the main determinant for the presence of CHD (p= 0.0044).
Conclusions: We conclude that LVH was present in about 46% of hypertensives with metabolic syndrome and the main determinant was the fasting plasma glucose to insulin ratio, while duration of hypertension was also a significant factor for the development of CHD.