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Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study

Journal of Human Hypertension volume 21, pages 625–632 (2007)Cite this article

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 (4.8±1.1 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.

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Acknowledgements

This work was supported in part by grant COZ-368 from Merck & Co., Inc.

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Authors and Affiliations

  1. The Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy

    G de Simone

  2. Division of Cardiology, Weill Medical College of Cornell University, New York, NY, USA

    G de Simone, K Wachtell & R B Devereux

  3. Department of Medicine, Glostrup University Hospital, Glostrup, Denmark

    M H Olsen & H Ibsen

  4. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

    K Wachtell

  5. Merck Research Laboratories, West Point, PA, USA

    D A Hille & P A Lyle

  6. Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden

    B Dahlöf

  7. University of Oslo Ullevaal Hospital, Oslo, Norway

    S E Kjeldsen

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  1. G de Simone
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Correspondence to G de Simone.

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This trial is registered at clinicaltrials.gov as NCT00338260.

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de Simone, G., Olsen, M., Wachtell, K. et al. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens 21, 625–632 (2007). https://doi.org/10.1038/sj.jhh.1002203

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