inteRvention and PRevention Metabolic SyndroMe, Heart diSeaSeS, and Gender diSparity

Metabolic SyndroMe, Heart diSeaSeS, and Gender diSparity Clinical and experimental evidence has demonstrated that risk factors for cardi­ ovascular disease often cluster together, most notably overweight/obesity, dia­ betes mellitus, dyslipidemia, and hyper­ tension (1). Over the past several decades, the intensive clinical management to fight against cardiovascular diseases has resulted in a dramatic reduction in car­ diovascular mortality. However, many patients still fail to achieve adequate and satisfactory clinical management of car­ diovascular risk factors. In addition, the growing prevalence of obesity (~66% of Americans are overweight or obese) and type 2 diabetes mellitus threatens to undermine the improvement in the man­ agement of cardiovascular diseases (2). Even modest excess body weight gain may lead to a significant increase in the risk of cardiovascular mortality. The increased incidence of obesity may also predispose the onset of other key cardio­ vascular risk factors such as hyperten­ sion, dyslipidemia, insulin resistance, and type 2 diabetes (2). This cluster of risk factors has been collectively known as cardiometabolic syndrome or meta­ bolic syndrome after the beginning of this century. In essence, unlike diabetes, met­ abolic syndrome is not a specific disease but rather a cluster of factors predisposing to the development of cardiovascular dis­ eases. Since its appearance in the medical vernacular two decades ago, the cardio­ vascular sequelae of metabolic syndrome have been widely recognized. Recent criteria consider metabolic syndrome as a cluster of symptoms including large waist size (central obesity), hypertension, hyperglycemia, dyslipidemia, and insulin resistance, all commonly associated with the increased prevalence of obesity and type 2 diabetes mellitus (3). Moreover, metabolic syndrome may lead to dete­ riorated cardiac geometry and function independent of any macrovascular and microvascular diseases (4,5). Myocardial contractile dysfunction especially diasto­ lic dysfunction is the most prominent cardiac defect associated with metabolic syndrome especially obesity and type 2 diabetes characterized by reduced ven­ tricular compliance and myocardial relaxation (4–6). Systolic and diastolic dysfunctions are usually manifested as prolonged ventricular contraction and relaxation duration, reduced velocity