{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:09:34Z","timestamp":1785769774845,"version":"3.56.0"},"reference-count":92,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Metabolic syndrome (MetS) encompasses a cluster of interrelated conditions, including obesity, hyperglycemia, hyperlipidemia, and hypertension, and has been established as a significant risk factor for cardiovascular events and heightened mortality. At its core, insulin resistance serves as the primary underlying mechanism driving the development of MetS. The prevalence of MetS is rising at an alarming rate, posing a significant public health challenge worldwide. Even in the absence of overt obstructive coronary artery disease or valvular heart disease, patients with MetS often exhibit adverse cardiac remodeling and myocardial dysfunction. Left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) are the leading manifestations of heart failure with preserved ejection fraction (HFpEF). Abnormal myocardial substrate utilization, neurohormonal activation, interstitial fibrosis, coronary microvascular dysfunction, and metabolic inflammation have all been implicated in the development and progression of adverse cardiac remodeling associated with MetS. However, despite the tremendous research produced on this subject, HFpEF remains highly prevalent in such a population. The early diagnosis of abnormal cardiac remodeling would enable optimal effective therapies to prevent the progression of the disease to the symptomatic phase. HFpEF encompasses a diverse range of pathological processes. In these patients, LVDD and elevated left ventricular filling pressure are the primary manifestations. Echocardiography remains the popular imaging modality for the assessment of LVDD and LV filling pressure. The article aims to review recent articles covering the association between MetS components or MetS and LVDD in HFpEF.<\/jats:p>","DOI":"10.3389\/fendo.2025.1544908","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T04:10:38Z","timestamp":1744603838000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Metabolic syndrome, left ventricular diastolic dysfunction and heart failure with preserved ejective fraction"],"prefix":"10.3389","volume":"16","author":[{"given":"Dan","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuisheng","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongchen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huixia","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S","article-title":"Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation","volume":"15","author":"Alberti","year":"1998","journal-title":"Diabetes Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.19.2486","article-title":"Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III)","volume":"285","year":"2001","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67402-8","article-title":"The metabolic syndrome\u2013a new worldwide definition","volume":"366","author":"Alberti","year":"2005","journal-title":"Lancet (London England)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.169404","article-title":"Diagnosis and management of the metabolic syndrome: an American Heart Association\/National Heart, Lung, and Blood Institute Scientific Statement","volume":"112","author":"Grundy","year":"2005","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.023","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography","volume":"22","author":"Nagueh","year":"2009","journal-title":"J Am Soc Echocardiography: Off Publ Am Soc Echocardiography"},{"key":"B8","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the american society of echocardiography and the european association of cardiovascular imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiography: Off Publ Am Soc Echocardiography"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.07.029","article-title":"Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction","volume":"11","author":"Morris","year":"2018","journal-title":"JACC Cardiovasc imaging"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeab154","article-title":"Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging","volume":"23","author":"Smiseth","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/jch.14262","article-title":"Age-related alterations in cardiac and arterial structure and function in hypertensive women and men","volume":"23","author":"Cai","year":"2021","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.07.029","article-title":"Coronary flow reserve abnormalities in patients with diabetes mellitus who have end-stage renal disease and normal epicardial coronary arteries","volume":"147","author":"Ragosta","year":"2004","journal-title":"Am Heart J"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1042\/CS20080390","article-title":"Role of the renin-angiotensin-aldosterone system and inflammatory processes in the development and progression of diastolic dysfunction","volume":"116","author":"Sciarretta","year":"2009","journal-title":"Clin Sci (London England: 1979)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2010.235","article-title":"Diagnosis and management of left ventricular diastolic dysfunction in the hypertensive patient","volume":"24","author":"Galderisi","year":"2011","journal-title":"Am J hypertension"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2015.1","article-title":"Blood pressure and arterial stiffness in patients with high sodium intake in relation to sodium handling and left ventricular diastolic dysfunction status","volume":"29","author":"Cwynar","year":"2015","journal-title":"J Hum hypertension"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000024573.17293.23","article-title":"TIMP-1: a marker of left ventricular diastolic dysfunction and fibrosis in hypertension","volume":"40","author":"Lindsay","year":"2002","journal-title":"Hypertension (Dallas Tex: 1979)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1186\/s12872-022-02709-3","article-title":"Prevalence and prognosis of left ventricular diastolic dysfunction in community hypertension patients","volume":"22","author":"Zhou","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2006.02.009","article-title":"Tissue velocity echocardiography shows early improvement in diastolic function with irbesartan and atenolol therapy in patients with hypertensive left ventricular hypertrophy. Results form the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA)","volume":"19","author":"M\u00fcller-Brunotte","year":"2006","journal-title":"Am J hypertension"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2003.10.018","article-title":"Regression of left ventricular hypertrophy and improvement of diastolic function in hypertensive patients treated with telmisartan","volume":"97","author":"Mattioli","year":"2004","journal-title":"Int J Cardiol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.138529","article-title":"Effect of intensive versus standard blood pressure lowering on diastolic function in patients with uncontrolled hypertension and diastolic dysfunction","volume":"55","author":"Solomon","year":"2010","journal-title":"Hypertension (Dallas Tex: 1979)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s11906-007-0086-3","article-title":"Diabetic cardiomyopathy","volume":"9","author":"Karnik","year":"2007","journal-title":"Curr hypertension Rep"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/diab.28.8.713","article-title":"Capillary basal laminar thichness in diabetic human myocardium","volume":"28","author":"Fischer","year":"1979","journal-title":"Diabetes"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(80)90243-4","article-title":"Primary myocardial disease, diabetes mellitus, and small vessel disease","volume":"100","author":"Zoneraich","year":"1980","journal-title":"Am Heart J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.jacc.2005.09.050","article-title":"The pathogenesis of myocardial fibrosis in the setting of diabetic cardiomyopathy","volume":"47","author":"Asbun","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.51.2.317","article-title":"Dynamic determinants of letf ventricular diastolic pressure-volume relations in man","volume":"51","author":"Gaasch","year":"1975","journal-title":"Circulation"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01230-X","article-title":"The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the Strong Heart Study","volume":"37","author":"Liu","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1093\/ehjci\/jew331","article-title":"Diastolic function deterioration in type 2 diabetes mellitus: predictive factors over a 3-year follow-up","volume":"19","author":"Bergerot","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2010.03221.x","article-title":"Cardiovascular autonomic neuropathy contributes to left ventricular diastolic dysfunction in subjects with Type 2 diabetes and impaired glucose tolerance undergoing coronary angiography","volume":"28","author":"Dinh","year":"2011","journal-title":"Diabetes Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12573","article-title":"A diabetes-associated genetic variant is associated with diastolic dysfunction and cardiovascular disease","volume":"7","author":"Molvin","year":"2020","journal-title":"ESC Heart failure"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2016.0064","article-title":"Left ventricular diastolic dysfunction in normotensive postmenopausal women with type 2 diabetes mellitus","volume":"24","author":"Maiello","year":"2017","journal-title":"Cardiol J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s12933-020-01139-9","article-title":"Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults","volume":"19","author":"Steele","year":"2020","journal-title":"Cardiovasc Diabetol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-021-01822-7","article-title":"Evaluation of left ventricular systolic and diastolic function in subjects with prediabetes and diabetes using cardiovascular magnetic resonance-feature tracking","volume":"59","author":"Zhou","year":"2022","journal-title":"Acta Diabetol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12933-018-0717-9","article-title":"Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes","volume":"17","author":"Matsutani","year":"2018","journal-title":"Cardiovasc Diabetol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.v19:6","article-title":"Left-ventricular diastolic dysfunction may be prevented by chronic treatment with PPAR-alpha or -gamma agonists in a type 2 diabetic animal model","volume":"19","author":"Kim","year":"2003","journal-title":"Diabetes Metab Res Rev"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3283480fe9","article-title":"Effects of perindopril-indapamide on left ventricular diastolic function and mass in patients with type 2 diabetes: the ADVANCE Echocardiography Substudy","volume":"29","author":"Investigators","year":"2011","journal-title":"J hypertension"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-017-6734-1","article-title":"Empagliflozin improves left ventricular diastolic dysfunction in a genetic model of type 2 diabetes","volume":"31","author":"Hammoudi","year":"2017","journal-title":"Cardiovasc Drugs Ther"},{"key":"B37","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1186\/s12933-023-02023-y","article-title":"Sodium-glucose cotransporter-2 inhibition for heart failure with preserved ejection fraction and chronic kidney disease with or without type 2 diabetes mellitus: a narrative review","volume":"22","author":"Mentz","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur Heart J"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-019-00381-1","article-title":"Effects of metformin on left ventricular size and function in hypertensive patients with type 2 diabetes mellitus: results of a randomized, controlled, multicenter, phase IV trial","volume":"20","author":"Ono","year":"2020","journal-title":"Am J Cardiovasc Drugs"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0081798","article-title":"Obesity is associated with lower coronary microvascular density","volume":"8","author":"Campbell","year":"2013","journal-title":"PloS One"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2011.30","article-title":"The relationship among central obesity, systemic inflammation, and left ventricular diastolic dysfunction as determined by structural equation modeling","volume":"20","author":"Wu","year":"2012","journal-title":"Obes (Silver Spring)"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.033521","article-title":"Obesity and risk of incident left ventricular hypertrophy in community-dwelling populations with hypertension: an observational study","volume":"13","author":"Cai","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2014.04.010","article-title":"Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and management","volume":"164","author":"Alpert","year":"2014","journal-title":"Trans research: J Lab Clin Med"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.115.05478","article-title":"Cardiac metabolic alterations in hypertensive obese pigs","volume":"66","author":"Zhang","year":"2015","journal-title":"Hypertension (Dallas Tex: 1979)"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00505-5","article-title":"Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss","volume":"80","author":"Alpert","year":"1997","journal-title":"Am J Cardiol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20907","article-title":"Strain imaging in morbid obesity: insights into subclinical ventricular dysfunction","volume":"34","author":"Barbosa","year":"2011","journal-title":"Clin Cardiol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000147184.13872.0F","article-title":"Alterations of left ventricular myocardial characteristics associated with obesity","volume":"110","author":"Wong","year":"2004","journal-title":"Circulation"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.11.054","article-title":"Contribution of central adiposity to left ventricular diastolic function (from the Baltimore Longitudinal Study of Aging)","volume":"109","author":"Canepa","year":"2012","journal-title":"Am J Cardiol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2013.04.003","article-title":"The relationship between visceral adiposity and left ventricular diastolic function: results from the Baltimore Longitudinal Study of Aging","volume":"23","author":"Canepa","year":"2013","journal-title":"Nutrition metabolism Cardiovasc diseases: NMCD"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1038\/nutd.2014.3","article-title":"Adipocyte fatty acid-binding protein levels are associated with left ventricular diastolic dysfunction in morbidly obese subjects","volume":"4","author":"Baessler","year":"2014","journal-title":"Nutr Diabetes"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs116","article-title":"Growth-differentiation factor-15 improves reclassification for the diagnosis of heart failure with normal ejection fraction in morbid obesity","volume":"14","author":"Baessler","year":"2014","journal-title":"Eur J Heart failure"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.3.1620","article-title":"Association of reduced carbon monoxide diffusing capacity with moderate or severe left ventricular diastolic dysfunction in obese persons","volume":"128","author":"Ravipati","year":"2005","journal-title":"Chest"},{"key":"B53","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.metabol.2019.05.007","article-title":"Effects of sarcopenia, body mass indices, and sarcopenic obesity on diastolic function and exercise capacity in Koreans","volume":"97","author":"Jung","year":"2019","journal-title":"Metabolism"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.v37.1","article-title":"Relationship between low skeletal muscle mass, sarcopenic obesity and left ventricular diastolic dysfunction in Korean adults","volume":"37","author":"Yoo","year":"2021","journal-title":"Diabetes Metab Res Rev"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1111\/eci.2013.43.issue-11","article-title":"The effect of bariatric surgery on echocardiographic indices: a review of the literature","volume":"43","author":"Grapsa","year":"2013","journal-title":"Eur J Clin Invest"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.145136","article-title":"Nebivolol improves diastolic dysfunction and myocardial remodeling through reductions in oxidative stress in the Zucker obese rat","volume":"55","author":"Zhou","year":"2010","journal-title":"Hypertension (Dallas Tex: 1979)"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25084407","article-title":"New mechanisms to prevent heart failure with preserved ejection fraction using glucagon-like peptide-1 receptor agonism (GLP-1 RA) in metabolic syndrome and in type 2 diabetes: A review","volume":"25","author":"Jalil","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B58","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.metabol.2017.08.008","article-title":"Enhanced endothelium epithelial sodium channel signaling prompts left ventricular diastolic dysfunction in obese female mice","volume":"78","author":"Jia","year":"2018","journal-title":"Metabolism"},{"key":"B59","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.yjmcc.2018.08.017","article-title":"Cilostazol ameliorates heart failure with preserved ejection fraction and diastolic dysfunction in obese and non-obese hypertensive mice","volume":"123","author":"Reddy","year":"2018","journal-title":"J Mol Cell Cardiol"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1042\/CS20210127","article-title":"Lipotoxicity: a driver of heart failure with preserved ejection fraction","volume":"135","author":"Leggat","year":"2021","journal-title":"Clin Sci (London England: 1979)"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.5551\/jat.40956","article-title":"A high-fat and high-cholesterol diet induces cardiac fibrosis, vascular endothelial, and left ventricular diastolic dysfunction in SHRSP5\/dmcr rats","volume":"25","author":"Watanabe","year":"2018","journal-title":"J Atheroscler Thromb"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.2337\/db07-0768","article-title":"Short-term caloric restriction induces accumulation of myocardial triglycerides and decreases left ventricular diastolic function in healthy subjects","volume":"56","author":"van der Meer","year":"2007","journal-title":"Diabetes"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.90413.2008","article-title":"Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus","volume":"295","author":"Hammer","year":"2008","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.07.002","article-title":"Early left ventricular abnormalities in children with heterozygous familial hypercholesterolemia","volume":"25","author":"Di Salvo","year":"2012","journal-title":"J Am Soc Echocardiography: Off Publ Am Soc Echocardiography"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.583","article-title":"The effect of blood lipids on the left ventricle: A mendelian randomization study","volume":"76","author":"Aung","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1248\/bpb.b15-00126","article-title":"Early impairment of left ventricular function in hypercholesterolemia and its reversibility after short term treatment with rosuvastatin A preliminary echocardiographic study","volume":"197","author":"Talini","year":"2008","journal-title":"Atherosclerosis"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1248\/bpb.b15-00126","article-title":"Effects of statins on left ventricular diastolic function in patients with dyslipidemia and diastolic dysfunction (Stat-LVDF study)","volume":"38","author":"Morimoto","year":"2015","journal-title":"Biol Pharm bulletin"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.04.029","article-title":"HDL mimetic peptide CER-522 treatment regresses left ventricular diastolic dysfunction in cholesterol-fed rabbits","volume":"215","author":"Merlet","year":"2016","journal-title":"Int J Cardiol"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S300450","article-title":"Significant association between left ventricular diastolic dysfunction, left atrial performance and liver stiffness in patients with metabolic syndrome and non-alcoholic fatty liver disease","volume":"14","author":"Parvanescu","year":"2021","journal-title":"Diabetes Metab syndrome obesity: Targets Ther"},{"key":"B70","doi-asserted-by":"publisher","DOI":"10.1515\/med-2019-0073","article-title":"Echocardiography evaluation of left ventricular diastolic function in elderly women with metabolic syndrome","volume":"14","author":"Chung","year":"2019","journal-title":"Open Med (Wars)"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008856","article-title":"Burden of uncontrolled metabolic risk factors and left ventricular structure and function in patients with type 2 diabetes mellitus","volume":"7","author":"Jorgensen","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2017-000484","article-title":"Cardiac structure and function with and without metabolic syndrome: the Echocardiographic Study of Latinos (Echo-SOL)","volume":"6","author":"Burroughs Pena","year":"2018","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.1002\/oby.v21.12","article-title":"Myocardial deformation and twist mechanics in adults with metabolic syndrome: impact of cumulative metabolic burden","volume":"21","author":"Crendal","year":"2013","journal-title":"Obes (Silver Spring)"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl526","article-title":"Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass","volume":"28","author":"de las Fuentes","year":"2007","journal-title":"Eur Heart J"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13478","article-title":"Positive additive interaction effects of age, sex, obesity, and metabolic syndrome on left ventricular dysfunction","volume":"16","author":"Zhou","year":"2024","journal-title":"J Diabetes"},{"key":"B76","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.ijcard.2023.03.024","article-title":"Metabolic syndrome and risk of incident heart failure in non-diabetic patients with established cardiovascular disease","volume":"379","author":"Burger","year":"2023","journal-title":"Int J Cardiol"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jer291","article-title":"Integrated backscatter as a fibrosis marker in the metabolic syndrome: association with biochemical evidence of fibrosis and left ventricular dysfunction","volume":"13","author":"Kosmala","year":"2012","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.103.22.2668","article-title":"Glycemic control and heart failure among adult patients with diabetes","volume":"103","author":"Iribarren","year":"2001","journal-title":"Circulation"},{"key":"B79","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1161\/CIRCHEARTFAILURE.114.002026","article-title":"Preclinical systolic and diastolic dysfunctions in metabolically healthy and unhealthy obese individuals","volume":"8","author":"Wang","year":"2015","journal-title":"Circ Heart Fail"},{"key":"B80","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.amjhyper.2005.07.024","article-title":"Metabolic syndrome and morphofunctional characteristics of the left ventricle in clinically hypertensive nondiabetic subjects","volume":"19","author":"Grandi","year":"2006","journal-title":"Am J hypertension"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2014.01.002","article-title":"Is left ventricular diastolic dysfunction independent from presence of hypertension in metabolic syndrome? An echocardiographic study","volume":"64","author":"Aksoy","year":"2014","journal-title":"J Cardiol"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015150035","article-title":"Association between hepatic triglyceride content and left ventricular diastolic function in a population-based cohort: the Netherlands epidemiology of obesity study","volume":"279","author":"Widya","year":"2016","journal-title":"Radiology"},{"key":"B83","doi-asserted-by":"publisher","DOI":"10.1089\/met.2016.0021","article-title":"Determinants of improvement in left ventricular diastolic function following a 1-year lifestyle modification program in abdominally obese men with features of the metabolic syndrome","volume":"14","author":"Leclerc","year":"2016","journal-title":"Metab syndrome related Disord"},{"key":"B84","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2011.08.014","article-title":"A randomized study of the beneficial effects of aldosterone antagonism on LV function, structure, and fibrosis markers in metabolic syndrome","volume":"4","author":"Kosmala","year":"2011","journal-title":"JACC Cardiovasc imaging"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0257929","article-title":"A G-protein-biased S1P1 agonist, SAR247799, improved LVH and diastolic function in a rat model of metabolic syndrome","volume":"17","author":"Evaristi","year":"2022","journal-title":"PloS One"},{"key":"B86","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12933-020-00997-7","article-title":"Empagliflozin improved systolic blood pressure, endothelial dysfunction and heart remodeling in the metabolic syndrome ZSF1 rat","volume":"19","author":"Park","year":"2020","journal-title":"Cardiovasc Diabetol"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.1111\/jcmm.16122","article-title":"Linagliptin prevents left ventricular stiffening by reducing titin cleavage and hypophosphorylation","volume":"25","author":"Cuijpers","year":"2021","journal-title":"J Cell Mol Med"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.113.02093","article-title":"Calorie restriction attenuates cardiac remodeling and diastolic dysfunction in a rat model of metabolic syndrome","volume":"62","author":"Takatsu","year":"2013","journal-title":"Hypertension (Dallas Tex: 1979)"},{"key":"B89","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1093\/cvr\/cvt070","article-title":"HMGCoA reductase inhibition reverses myocardial fibrosis and diastolic dysfunction through AMP-activated protein kinase activation in a mouse model of metabolic syndrome","volume":"99","author":"Hermida","year":"2013","journal-title":"Cardiovasc Res"},{"key":"B90","doi-asserted-by":"publisher","first-page":"6a","DOI":"10.1016\/0735-1097(93)90455-A","article-title":"The epidemiology of heart failure: the Framingham Study","volume":"22","author":"Ho","year":"1993","journal-title":"J Am Coll Cardiol"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.06.013","article-title":"Preclinical left ventricular diastolic dysfunction in metabolic syndrome","volume":"114","author":"Ayalon","year":"2014","journal-title":"Am J Cardiol"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.02.039","article-title":"Metabolic syndrome and insulin resistance are associated with abnormal left ventricular diastolic function and structure independent of blood pressure and fasting plasma glucose level","volume":"159","author":"Hwang","year":"2012","journal-title":"Int J Cardiol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1544908\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T04:10:39Z","timestamp":1744603839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1544908\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":92,"alternative-id":["10.3389\/fendo.2025.1544908"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1544908","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]},"article-number":"1544908"}}