Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women.

Background: The metabolic syndrome is increasingly recognized as an important cardiovascular risk factor in hypertension, but its influence on left ventricular mass and function in the two genders has not been specifically addressed. Methods and Results: Among 351 men and 237 women with newly diagnosed, never treated essential hypertension who were free from diabetes and cardiovascular disease, echocardiographically-detected left ventricular mass was significantly greater in subjects with the metabolic syndrome. Compared to women without the metabolic syndrome, those with the syndrome had an 11% greater age-adjusted left ventricular mass index (95 vs 85 g×m-2, p<0.001), while the difference was not significant in men (106 vs 105 g×m-2, p=0.63). The metabolic syndrome was also associated to a depressed afterload-corrected midwall fractional shortening in women (95.0±13% vs 101.3±14%, p=0.002), but not in men (92.2±16% vs 93.7±14, p=0.44). After adjustment for the effect of age, body mass index, 24-hour systolic blood pressure, and several confounders, the metabolic syndrome was independently associated to a greater left ventricular mass in women (regression coefficient 12.0, p=0.013), but not in men. A greater prevalence of inappropriately high left ventricular mass was found in women (26% vs 6%, p<0.001), but not in men (26% vs 16%, p=0.09), with the metabolic syndrome. Conclusions: In untreated hypertension, metabolic syndrome has a different impact on left ventricular mass and function in men and women. The effect of metabolic syndrome is more pronounced in women, and is partly independent from the effect of several hemodynamic and non-hemodynamic determinants of left ventricular mass.