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Features of left ventricular hypertrophy in patients with metabolic syndrome with or without comparable blood pressure: a meta-analysis

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Abstract

The prevalence of metabolic syndrome (MS) has been on the rise over the past few decades, and this is associated with an increased incidence of target organ damage such as left ventricular hypertrophy (LVH). This meta-analysis aims to evaluate the features of LVH in MS patients with or without high blood pressure (BP). PubMed, Cochrane Library, Embase, Science Citation Index, and China Biology Medicine Disc, WanFang data, China National Knowledge Infrastructure database, and VIP were searched. Cross-sectional studies which directly compared LVH in hypertensive patients with MS and those with hypertension alone were identified. The following parameters were analyzed: systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular mass/height2.7 (LVM/h2.7), interventricular septum thickness (IVSt), left ventricular end-diastolic diameter (LVEDd), left ventricular posterior wall (LVPW), ratio of early to late diastolic peak flow velocity (E/A), and relative wall thickness (RWT). Data were extracted and analyzed by Cochrane Collaboration’s RevMan 5.0 software. 14 studies involving 5,994 patients were included. In four studies, MS patients with comparable level of BP had higher SBP (mmHg) [Mean Difference (MD) = 2.28, 95 % confidence intervals (CI): −0.58 to 5.13], DBP (mmHg) (MD = 1.32, 95 % CI: −0.23 to 2.87), LVM (g) (MD = 42.10, 95 % CI: 6.92–77.28), LVMI (g/m2) (MD = 8.93, 95 % CI: 5.29–12.57), LVM/h2.7 (g/m2.7) (MD = 5.40, 95 % CI: 2.51–8.29), IVSt (mm) (MD = 0.49, 95 % CI: 0.28–0.71), LVEDd (mm) (MD = 1.04, 95 % CI: −1.10 to 3.18), LVPW (mm) (MD = 0.75, 95 % CI: 0.13–1.37), RWT (MD = 0.06, 95 % CI: −0.00 to 0.12), and lower E/A (MD = −0.08, 95 % CI: −0.18 to 0.02) when compared to the patients with hypertension alone. In other ten studies, the hypertensive patients with MS exhibited higher levels of SBP (mmHg) (MD = 4.67, 95 % CI: 2.72–6.62), DBP (mmHg) (MD = 2.03,95 % CI: 1.40–2.65), LVM (g) (MD = 24.79, 95 % CI: 20.21–29.36), LVMI(g/m2) (MD = 9.22, 95 % CI: 2.81–15.64), LVM/h2.7 (g/m2.7) (MD = 5.97, 95 % CI: 4.14–7.80), IVSt (mm) (MD = 0.63, 95 % CI: 0.58–0.69), LVEDd (mm) (MD = 1.11, 95 % CI: 0.42–1.80), LVPW (mm) (MD = 0.63, 95 % CI: 0.31–0.94), RWT (MD = 0.02, 95 % CI: 0.01–0.03), as compared to patients with hypertension alone (P < 0.05). In addition, the MS patients combining with hypertension showed a lower E/A (MD = −0.07, 95 % CI: −0.10 to −0.04) when compared to those with hypertension alone. This study suggests that MS plays an important role in the development of LVH. MS seems to amplify hypertension-related cardiac changes. Furthermore, MS combining with higher level of BP will aggravate LVH and damage the diastolic function of left ventricle.

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Acknowledgments

This study was funded by the key Project of Traditional Chinese Medicine in Gansu Province of China (Code: GZK-2001-Z1); the Science and Technology Support Project in Gansu Province of China (Code: 0709TCYA068), and the Research Grant of the Second Hospital of Lanzhou University (Code: 2010-yj02).

Conflict of interest

None declared.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, The Second Hospital of Lanzhou University, Lanzhou, 730030, Gansu, China

    Ning-yin Li, Jing Yu, Xiao-wei Zhang, Shi-xiong Wang, Peng Chang, Qi Ding, Rui-xin Ma, Qun-fei Chen, Feng Zhao & Feng Bai

  2. Division of Hypertension, The Second Hospital of Lanzhou University, 82 Cuiyingmen Road, Lanzhou, 730030, Gansu, China

    Jing Yu

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  1. Ning-yin Li
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Correspondence to Jing Yu.

Appendices

Appendix 1: Search strategy to identify studies on the association of MS and LVH in hypertensive patients

Embase, Cochrane library, and Science Citation Index

MeSH terms

  1. 1.

    “Metabolic syndrome X”

  2. 2.

    “Hypertension”

  3. 3.

    “Hypertrophy, left ventricular”

  4. 4.

    “Cross-sectional studies”

Text terms

  1. 5.

    “Metabolic syndrome”

  2. 6.

    “MS”

  3. 7.

    “Hypertension”

  4. 8.

    “Hypertensive”

  5. 9.

    “Left ventricular hypertrophy”

  6. 10.

    “LVH”

  7. 11.

    “Observational studies” OR “cross-sectional studies”

Search strings (all inclusive):

  1. 12.

    1 OR 5 OR 6

  2. 13.

    2 OR 7 OR 8

  3. 14.

    3 OR 9 OR 10

  4. 15.

    4 OR 11

  5. 16.

    12 AND 13 AND 14 AND 15

China Biology Medicine Disc, WanFang data, China National Knowledge Infrastructure database, and VIP

Text terms

  1. 1.

    “Metabolic syndrome”

  2. 2.

    “Hypertension”

  3. 3.

    “Left ventricular hypertrophy”

  4. 4.

    “Observational studies” OR “cross-sectional studies”

Search strings (all inclusive):

  1. 5.

    1 AND 2 AND 3 AND 4

Appendix 2: Search strategy for Pubmed developed according to Biondi-Zoccaiet et al.

Metabolic syndrome AND hypertension AND left ventricular hypertrophy AND (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (clinical trial[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind[tw])) OR (latin square[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR comparative study[tw] OR evaluation studies[mh] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh]) NOT (comment[pt] OR editorial[pt] OR meta-analysis[pt] OR practice-guideline[pt] OR review[pt]).

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Li, Ny., Yu, J., Zhang, Xw. et al. Features of left ventricular hypertrophy in patients with metabolic syndrome with or without comparable blood pressure: a meta-analysis. Endocrine 43, 548–563 (2013). https://doi.org/10.1007/s12020-013-9883-4

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  • DOI: https://doi.org/10.1007/s12020-013-9883-4

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