OBESITY | VOLUME 17 NUMBER 1 | JANUARY 2009 177 nature publishing group ARTICLES EPIDEMIOLOGY INTRODUCTION he continuing burden of cardiovascular disease and, especially, hypertension is driven by the current epidemic of abdominal obesity that largely reverses the beneicial impact of favorable trends in smoking and hypercholesterolemia control (1). he INTERHEART study conirmed the importance of abdomi- nal adiposity as a risk factor for myocardial infarction (2) and recently the IDEA study showed the graded relationship between waist circumference, with both cardiovascular disease and diabetes mellitus at all levels of BMI, most importantly even in lean subjects (3). his is due to the fact that intra-abdominal adiposity enhances cardiometabolic risk promoting insulin resistance, dyslipidemia, and hypertension (4). he prevalence of both hypertension and abdominal obes- ity is higher in postmenopausal women compared to men (5). Furthermore, it is established that obesity and hypertension deteriorate let-ventricular (LV) hypertrophy and diastolic function more in an additive than in a synergistic manner, increasing the risk of congestive heart failure (6,7). Whether there is a sex-speciic role of excess visceral fat accumulation in hypertension-induced cardiac adaptations is not well clariied. herefore, the aim of the present study was to assess the dif- ferential efect of waist circumference on hypertension-related LV structural and functional alterations, in hypertensive males and females. METHODS AND PROCEDURES Study population and design Beginning in October 2003, all patients with essential hypertension who referred or self-referred to the outpatient hypertensive clinic of our institution were asked to participate in the Hippokration Hellenic Impact of Waist Circumference on Cardiac Phenotype in Hypertensives According to Gender Costas P. Tsioufis 1 , Dimitris L. Tsiachris 1 , Maria N. Selima 1 , Kyriakos S. Dimitriadis 1 , Costas G. Thomopoulos 1 , Dimitris C. Tsiliggiris 1 , Aliki S. Gennadi 1 , Dimitris C. Syrseloudis 1 , Elli S. Stefanadi 1 , Kostas P. Toutouzas 1 , Ioannis E. Kallikazaros 2 and Christodoulos I. Stefanadis 1 Our aim was to assess the differential effect of waist circumference on left-ventricular (LV) structural and functional alterations, in hypertensive males and females. One thousand seven hundred and eighty nine consecutive, nondiabetic, essential hypertensives (aged 55.8 ± 13.5 years, 966 females), included in the 3H Study, an ongoing registry of hypertension-related–target-organ damage, were classified to obese and nonobese groups according to Adult Treatment Panel III criteria. All participants underwent complete echocardiographic study including LV diastolic function evaluation by means of conventional and tissue Doppler imaging (TDI) methods, averaging early and late diastolic mitral annular peak velocities (Em, Am, Em/Am) from four separate sites of measurement. Hypertensive obese women compared with nonobese exhibited significantly greater LV mass index and prevalence of LV hypertrophy (by 5.5 g/m 2 , P = 0.003, and 8.8%, P = 0.005, respectively), while such differences were not present among men. Obese women compared to nonobese ones were accompanied by lower transmitral E/A (by 0.08, P < 0.001), TDI-derived Em/Am (by 0.12, P < 0.001), and higher E/Em ratio (by 0.8, P = 0.016). In contrast, hypertensive obese men compared to nonobese ones exhibited lower E and Em (by 0.04 m/s and 0.6 cm/s, both P < 0.05). A significant interaction between sex and abdominal obesity was observed only regarding TDI-derived Am and Em/Am. Furthermore, waist circumference was a predictor of E/A (β = –0.097, P = 0.002) and Em/Am (β = –0.116, P = 0.001), independently of body size, in females but not in males. The adverse effect of abdominal obesity on LV alterations is more pronounced among female hypertensives, suggesting that routine measurement of waist circumference provides additional information on cardiac phenotype especially in women. Obesity (2008) 17, 177–182. doi:10.1038/oby.2008.462 1 First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece; 2 Department of Cardiology, Hippokration Hospital, Athens, Greece. Correspondence: Costas Tsioufis (ktsioufis@hippocratio.gr) Received 25 February 2008; accepted 6 July 2008; published online 23 October 2008. doi:10.1038/oby.2008.462