*2.2.2 Left ventricular hypertrophy*

LVH is an independent predictor of morbidity and mortality including disabling events such as sudden death, myocardial infarction and stroke. Echo-based LVH is a well-established predictor of CV morbidity and mortality in either the general population or high-risk groups. LVH has been found to be the most powerful risk factor for sudden death, ventricular arrhythmias, myocardial ischemia, CHD, and congestive heart failure. LVH regression due to treatment of hypertension predicts an improved prognosis. Abnormal LV geometry in hypertensive patients is frequently associated with diastolic dysfunction, which can be further evaluated, by a combination of transmitral flow and tissue Doppler studies. Aging–associated vascular remodeling and insulin resistance with subsequent constellation of multiple CVD risk factors might have led to LVH [33] with elevated 10-year global cardiovascular risk as observed in our airmen. Insulin resistance and subsequent hyperinsulinemia have been reported to activate the sympathetic nervous and the renin angiotensin systems resulting in endothelial dysfunction. With reference to

Laplace's law, high blood pressure and obesity could trigger cardiac remodeling through hemodynamic and humoral mechanisms and the thickening of cardiac wall may occur through collagen deposits. It has been reported that moderate to severe LVH, of mainly concentric geometric subtype is a common finding among aircrew with age, subclinical atherosclerosis and components of the MetS as its main associated CV risk factors [34].
