Inflammation and ventricular-vascular coupling in hypertensive patients with metabolic syndrome

https://doi.org/10.1016/j.numecd.2018.08.003Get rights and content
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Highlights

In hypertensive patients with MetS:

  1. cardiovascular ageing is accelerated and dependent on inflammation.

  2. Inflammation and insulin resistance leads to vascular dysfunction.

  3. vascular dysfunction leads to ventricular dysfunction.

Abstract

Background and aims

Metabolic syndrome (MetS) is currently considered to raise the risk for type 2 diabetes and cardiovascular events. It has been suggested that part of this risk excess may be due to a cluster of additional factors associated with MetS. We aimed to investigate the role of inflammation on the ventricular-vascular coupling in patients with MetS.

Methods and results

We enrolled a total of 227 hypertensive patients (106 with MetS and 121 without MetS) matched for age and gender. Aortic pulse wave velocity (aPWV), intima-media thickness (IMT) and high sensitivity C-reactive protein (CRP) increased according to the number of MetS components. Patients with MetS showed increased aPWV (11.5 ± 3.7 vs. 10.3 ± 2.5 m/s, P = 0.03) compared with controls. In a model adjusted for age, sex, heart rate and mean blood pressure, aPWV resulted increased in patients with CKD (beta 1.29 m/s, 95%CI 0.61–1.96 m/s, P < 0.001) and MetS (beta 0.89 m/s, 95%CI 0.28–1.51 m/s, P = 0.005). After additional adjustment for CRP and IMT, the slope of aPWV was respectively reduced by 16% and 62%, suggesting that inflammation and intima-media thickening could contribute to aortic stiffening in patients with MetS. In these patients, aPWV was also associated with left-ventricular mass index (beta 0.79 g/m2.7, 95%CI 0.05–1.52 g/m2.7, P = 0.05).

Conclusion

MetS is characterized by an inflammation-dependent acceleration in cardiovascular ageing. This pattern of pathophysiological abnormalities may contribute to amplify the burden of cardiovascular risk in patients with MetS.

Keywords

Arterial stiffness
Chronic kidney disease
Inflammation
Left ventricular mass index
Metabolic syndrome

Acronyms

BP
blood pressure
CKD
chronic kidney disease
CRP
C-reactive protein
EaI
effective arterial elastance
ELVI
elastance of ventricular function
GFR
glomerular filtration rate
IMT
intima-media thickness
LVMi
left ventricular mass index
MetS
metabolic syndrome
aPWV
aortic pulse wave velocity
TyG
triglyceride-glucose

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1

These authors have contributed equally.