Women presenting with either obesity alone or in the presence of metabolic syndrome have high rates of abnormal ultrasound findings, despite being identified as low risk by traditional risk assessment tools, according to the results of the HAPPY Heart trial presented at the American Society of Echocardiography (ASE) 21st Annual Scientific Sessions in San Diego this week.

Danya L. Dinwoodey, MD, of Massachusetts General Hospital in Boston, and colleagues, who conducted their study to examine the relationships between obesity, metabolic syndrome and the presence of abnormal ultrasound measures--including left atrial enlargement, left ventricular hypertrophy, diastolic dysfunction and an increased carotid intima-media thickness (CIMT) or carotid plaque--explained that both of these conditions have become increasingly recognized as important risk factors for cardiovascular disease.

In the HAPPY Heart (Heart Awareness and Primary Prevention in Your neighborhood) trial, the researchers recruited 51 asymptomatic Caucasian and Hispanic women, with an average age of 50.7 years, presenting with two or more traditional cardiac risk factors and a normal left ventricular ejection fraction. Each of the participants was screened with comprehensive echocardiography and carotid ultrasound at the time of enrollment.

According to the study authors, all of the 43 women who had complete ultrasound data yielded a traditional Framingham risk score of less than 10 percent, placing them in the low risk category for cardiovascular disease. Of these women, metabolic syndrome was found in 74 percent and obesity was present in 67 percent of the women.

Thirty percent of the women were found to have increased left atrial indexed volumes indentified by echocardiography, and no participants presented with increased wall mass indices. Evidence of diastolic dysfunction and carotid IMT greater than 75 percent for their age and race were each noted in 37 percent of the women, respectively. 

Among the women with metabolic syndrome, 75 percent yielded at least one abnormal ultrasound finding, and in the obese cohort, a clear correlation was observed between the number of the five metabolic syndrome components and the greater number of abnormal ultrasound findings, wrote the researchers, as 45 percent of these women had an increased CIMT.

“Screening women with obesity or metabolic syndrome with ultrasound may help to further risk stratify these patients and direct risk reduction strategies, particularly in women who are low risk,” concluded Dinwoodey. “The additional data provided by ultrasound can help to determine how aggressively to intervene with treatment—ultimately perhaps saving a life.”