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Vittorio Palmieri, Jonathan N. Bella, Metabolic Syndrome and Left Ventricular Structure and Functional Abnormalities, American Journal of Hypertension, Volume 19, Issue 2, February 2006, Pages 206–207, https://doi.org/10.1016/j.amjhyper.2005.10.012
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Metabolic syndrome is a pro-atherothrombotic condition predisposing to cardiovascular events. In their study, Grandi et al1 explored correlations of metabolic syndromes with subclinical cardiovascular organ damage, such as increased left ventricular mass and systolic and diastolic dysfunction. Such a target is relevant because left ventricular structural and functional abnormalities are independent predictors of cardiovascular events including congestive heart failure. Grandi et al suggested considering metabolic syndrome as a distinct condition requiring aggressive treatment strategies because the study showed that metabolic syndrome was more strongly correlated than its components with subclinical cardiovascular target organ damage.
In the study by Grandi et al,1 subjects with metabolic syndrome had higher left ventricular mass indexed for body surface area (g/m2) than those without metabolic syndrome (see Table 3 in that article). Therefore it appears that higher left ventricular mass associated with metabolic syndrome is not simply driven by obesity. In fact, indexation of left ventricular mass by body surface accounts for obesity-related increase in fat-free mass,2 which in turn is a strong correlate of left ventricular mass in the general population.3 Although all patients in this study were hypertensive, mean blood pressure (BP) measured in the clinic setting was higher in the metabolic syndrome group. In both regression models (see Table 4 of that article), 24-h systolic BP was a strong correlate of nonindexed left ventricular mass but did not exclude the correlation between metabolic syndrome (or body mass index) with left ventricular mass. Insulin resistance is supposed to be a relevant additive factor to left ventricular mass increase in such a context; however a recent study in a population-based sample found no correlation between insulin resistance and left ventricular mass after accounting for body size.4 Use of left ventricular mass indexed for body height (in meters) to the 2.7 power (g/m2.7) would have allowed more precise identification of the relative contribution of obesity, BP, and metabolic factors to left ventricular mass.
