Association of the metabolic syndrome with pulmonary venous hypertension
Open accessAbstract
Background Pulmonary venous hypertension (PVH) is a well-described cause of pulmonary hypertension (PH) in patients with left heart disease associated with elevated left heart filling pressure. PVH results from a number of processes, including left-sided valvular disease, constrictive pericardial disease, restrictive cardiomyopathies, and left ventricular (LV) systolic dysfunction. PVH in patients with normal LV systolic function, commonly referred to as diastolic dysfunction, is not well characterized. We observed that many patients with PH due to PVH have obesity, hypertension, diabetes mellitus, and hypercholesterolemia, which are clinical features of the metabolic syndrome (MS), a previously identified cause for systemic vascular disease.Methods We evaluated 122 consecutive patients referred for diagnosis and treatment of PH and compared the prevalence of features of the MS between patients with PVH and those with pulmonary arterial hypertension (PAH). We also compared clinical and hemodynamic characteristics between these two groups.Results Compared to patients with PAH, patients with PVH had a higher frequency of hypertension, obesity, diabetes mellitus, and hyperlipidemia. Two or more features of the MS were found in 16 of 17 patients with PVH (94.1%) compared with 34.3% of patients with PAH (p < 0.001; odds ratio, 30.7; 95% confidence interval, 3.6 to 260.0). PH was substantial, but less severe overall, in patients with PVH compared to those with PAH (mean pulmonary artery pressure, 45 +/- 17 mm Hg [range, 26 to 71 mm Hg] vs 53 +/- 10 [range, 33 to 72 mm Hg], respectively [p = 0.041]; and pulmonary vascular resistance, 4.4 +/- 2.9 units [range, 1.2 to 10.8 units] vs 10.8 +/- 4.7 units [range, 4.8 to 21.9 units], respectively [p < 0.001]).Conclusion PVH is highly associated with the MS. Our results suggest that the MS may predispose patients to develop pulmonary vascular disease.
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Many patients with PH share a common link to the metabolic syndrome.
“Despite the diversity of patients who develop PH, many share a common link to the metabolic syndrome[4,12–14].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [12]
Obesity, hyperlipidemia, and systemic hypertension are common risk factors for Group I PAH as well as Group II PH and are also a feature of HIV infection.
“For example, obesity, hyperlipidemia, and systemic hypertension are common risk factors for Group I PAH as well as Group II (secondary to left-sided heart failure or PH-heart failure with preserved ejection fraction, HFpEF)[12,15,16], and are also a feature of HIV infection[17,18].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [12]
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- Authors
- Robbins, I. M., Newman, J. H., Johnson, R. F., Hemnes, A. R., Fremont, R. D., Piana, R. N., Zhao, D. X., & Byrne, D. W.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Robbins, Ivan M.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 136
- Issue
- 1
- Pages
- 31-36
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC2716716
- OpenAlex
- W2135935974
- Cited by
- 171
- References
- 26
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 8 · 2019: 8 · 2018: 11 · 2017: 10 · 2016: 16 · 2015: 18 · 2014: 11 · 2013: 12 · 2012: 14
- FWCI
- 12.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHEST Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (P01 072058)
- National Heart, Lung, and Blood Institute (F32HL082132)
- National Center for Research Resources (M01RR000095, MO1-RR-00095)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- pulmonary venous hypertension, metabolic syndrome, pulmonary arterial hypertension, left heart disease, obesity, hypertension, diabetes mellitus, hyperlipidemia, pulmonary vascular resistance, diastolic dysfunction, pulmonary hypertension etiology
- MeSH terms
- Adult, Aged, Diastole, Female, Humans, Hypertension, Pulmonary, Male, Middle Aged, Pulmonary Artery, Pulmonary Veins, Retrospective Studies, Venous Pressure, Cohort Studies, Prevalence, Ventricular Dysfunction, Left, Metabolic Syndrome
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