Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy.
Nutr Metab Cardiovasc Dis. 2009 Nov;19(9):634-40. doi: 10.1016/j.numecd.2008.12.012. Epub 2009 Apr 10.
Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome predicted outcome in the LIFE study, independently of single risk markers, including obesity, diabetes and baseline ECG left ventricular hypertrophy (LVH). We examined whether clusters of two or more metabolic abnormalities (MetAb, including obesity, high plasma glucose without diabetes, low HDL-cholesterol) in addition to hypertension were associated to levels of ECG LVH reduction comparable to that obtained in hypertensive subjects without or with only one additional metabolic abnormality (no-MetAb).
We studied 5558 non-diabetic participants without MetAb (2920 women) and 1235 with MetAb (751 women) from the LIFE-study cohort. MetAb was defined by reported LIFE criteria, using partition values from the ATPIII recommendations. Time-trends of Cornell voltage-duration product (CP) over 5 years was assessed using a quadratic polynomial contrast, adjusting for age, sex, prevalent cardiovascular disease and treatment arm (losartan or atenolol). At baseline, despite similar blood pressures, CP was greater in the presence than in the absence of MetAb (p<0.0001). During follow-up, despite similar reduction of blood pressure, CP decreased less in patients with than in those without MetAb, even after adjustment for the respective baseline values (both p<0.002). Losartan was more effective than atenolol in reducing CP independently of MetAb.
Clusters of metabolic abnormalities resembling phenotypes of metabolic syndrome are related to greater initial ECG LVH in hypertensive patients with value of blood pressure similar to individuals without metabolic abnormalities, and are associated with less reduction of ECG LVH during antihypertensive therapy, potentially contributing to the reported adverse prognosis of metabolic syndrome.
类似于代谢综合征表型的代谢异常簇在 LIFE 研究中独立于肥胖、糖尿病和基线心电图左心室肥厚（LVH）等单一风险标志物预测结局。我们研究了除高血压外，两个或两个以上代谢异常（包括肥胖、无糖尿病的高血糖、低高密度脂蛋白胆固醇）的异常簇与心电图 LVH 降低程度的相关性，这种降低程度与高血压患者中没有或仅有一个额外代谢异常（无代谢异常）时的降低程度相当。
我们研究了 LIFE 研究队列中的 5558 名无代谢异常的非糖尿病患者（2920 名女性）和 1235 名有代谢异常的患者（751 名女性）。代谢异常是根据 LIFE 标准报告的，并使用 ATPIII 建议的分区值定义。使用二次多项式对比评估 5 年内康奈尔电压-持续时间乘积（CP）的时间趋势，调整年龄、性别、既往心血管疾病和治疗臂（氯沙坦或阿替洛尔）。在基线时，尽管血压相似，CP 在存在代谢异常时大于不存在代谢异常时（p<0.0001）。在随访期间，尽管血压下降相似，但与无代谢异常患者相比，有代谢异常患者的 CP 下降幅度较小，即使在调整各自的基线值后也是如此（均 p<0.002）。氯沙坦在独立于代谢异常的情况下降低 CP 的效果优于阿替洛尔。
类似于代谢综合征表型的代谢异常簇与高血压患者中更大的初始心电图 LVH 相关，这些患者的血压值与无代谢异常的个体相似，并且与降压治疗期间心电图 LVH 的减少程度相关，这可能导致代谢综合征的不良预后。
