1. ¹The Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
2. ²Division of Cardiology, Weill Medical College of Cornell University, New York, NY, USA
3. ³Department of Medicine, Glostrup University Hospital, Glostrup, Denmark
4. ⁴Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
5. ⁵Merck Research Laboratories, West Point, PA, USA
6. ⁶Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
7. ⁷University of Oslo Ullevaal Hospital, Oslo, Norway

Correspondence: Dr G de Simone, Department of Clinical and Experimental Medicine, Federico II University Hospital, Via S Pansini, No. 5, Building 1, Naples 80131, Italy. E-mail: simogi@unina.it

Received 19 October 2006; Revised 9 March 2007; Accepted 10 March 2007; Published online 3 May 2007.

Abstract

The relation of metabolic syndrome (MetS) with cardiovascular outcome may be less evident when preclinical cardiovascular disease is present. We explored, in a post hoc analysis, whether MetS predicts cardiovascular events in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. MetS was defined by 2 risk factors plus hypertension: body mass index 30 kg/m², high-density lipoprotein (HDL)-cholesterol <1.0/1.3 mmol/l (<40/50 mg/dl) (men/women), glucose 6.1 mmol/l (110 mg/dl) fasting or 7.8 mmol/l (140 mg/dl) nonfasting or diabetes. Cardiovascular death and the primary composite end point (CEP) of cardiovascular death, stroke and myocardial infarction were examined. In MetS (1591 (19.3%) of 8243 eligible patients), low HDL-cholesterol (72%), obesity (77%) and impaired glucose (73%) were similarly prevalent, with higher blood pressure, serum creatinine and Cornell product, but lower Sokolow–Lyon voltage (all P<0.001). After adjusting for baseline covariates, hazard ratios for CEPs and cardiovascular death (4.81.1 years follow-up) were 1.47 (95% confidence interval (CI), 1.27–1.71)- and 1.73 (95% CI, 1.38–2.17)-fold higher with MetS (both P<0.0001), and were only marginally reduced when further adjusted for diabetes, obesity, low HDL-cholesterol, non-HDL-cholesterol, pulse pressure and in-treatment systolic blood pressure and heart rate. Thus, MetS is associated with increased cardiovascular events in hypertensive patients with ECG-LVH, independently of single cardiovascular risk factors.