HF risk found in patients with metabolic syndrome

Voulgari C. J Am Coll Cardiol. 2011;58:1343-1350.

Issue: November 2011

Patients with metabolic syndrome who are normal weight have a higher risk of HF vs. patients without metabolic syndrome who are obese, according to a study.

In this prospective, community-based study taking place between 2003 and 2005, 550 participants were classified into groups based on presence (n=271) or absence (n=279) of metabolic syndrome and by BMI. Participants included did not have diabetes or macrovascular disease. Researchers assessed left ventricular functional capacity, myocardial structure and performance echocardiographically. Smoking and medication use information was obtained by researchers through standardized questionnaires. There was a median follow-up time of 6 years.

Participants who were normal weight (HR=2.33; 95% CI, 1.25-4.36) with metabolic syndrome had a higher HF risk than overweight (HR=1.12; 95% CI, 0.35-0.33) and obese (HR=0.41; 95% CI, 0.10-1.31) participants who did not, according to the study. Researchers found a consistent pattern between BMI, metabolic syndrome and HF incidence during the 6-year follow-up, in which participants without metabolic syndrome had HF incidence of 15.6% with a normal BMI, 14.2% in those overweight and 9.3% in those obese vs. 63.2% with a normal BMI, 47.7% in those overweight and 54.2% in those obese with metabolic syndrome.

HF developed in 185 participants during follow-up, and in these participants, LV hypertrophy (P=.001) and diastolic dysfunction with preserved LV ejection fraction (P<.001) was higher in BMI groups with metabolic syndrome vs. without. Overall, impaired fasting glucose (HR=1.09; 95% CI, 1.06-1.10), high BP (HR=2.36; 95% CI, 1.03-5.43), low HDL (HR=1.88; 95% CI, 1.29 to –2.77) and central obesity (HR=2.22; 95% CI, 1.02-1.05) were associated with increased HF risk in participants with metabolic syndrome.

“The metabolic syndrome, such as obesity, is considered a risk factor for the development of LV hypertrophy, LV dilation, myocardial dysfunction and clinical HF,” Eileen Hsich, MD, of the Kaufman Center for Heart Failure, Heart and Vascular Institute, at the Cleveland Clinic, said in an accompanying editorial. “Given the fact that the components of metabolic syndrome are known risk factors for HF, it is not surprising that metabolic syndrome is a stronger predictor of HF than simply one variable such as the presence of obesity.”

Disclosure: Dr. Hsich reports no relevant financial disclosures.

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