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The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests that the first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity). The treatment should be based on two major components: behavioral change to reduce caloric intake and an increase in physical activity. A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months. The general dietary recommendations include low intake of saturated fats, trans fats and cholesterol, and diets with low glycemic index. Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia. Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome. Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes. An equal balance between aerobic exercise and strength training is advised. Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals. There is no single best therapy and the treatment should consist of treatment of individual component(s). Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe. Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category. Some evidence suggests that angiotensin-converting enzyme inhibitors and β blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome. Patients with metabolic syndrome also have elevations in fibrinogen and other coagulation factors leading to prothrombotic state and aspirin may be beneficial for primary prevention in these patients. The new developments in the treatment of metabolic syndrome with drugs, such as peroxisome proliferator-activated receptor agonists, will broaden the horizons of the current treatment options in metabolic syndrome.
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References and Recommended Reading
Park Y, Zhu S, Palaniappan L, et al.: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2003, 163:427–436.
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) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [no authors listed]. JAMA 2001, 285:2486–2497.
Caprio S: Insulin resistance in childhood obesity. J Pediatr Endocrinol Metab 2002, 15(suppl 1):487–492.
Weiss R, Dziura J, Burgert T, et al.: Obesity and metabolic syndrome in children adolescents. N Engl J Med 2004, 350:2362–2374.
Sinha R, Fisch G, Teague B, et al.: Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002, 346:802–810.
Strauss RS, Pollack HA: Epidemic increase in childhood overweight, 1986–1998. JAMA 2001, 286:2845–2848.
Ford ES, Giles WH, Dietz WH: Prevalence of metabolic syndrome among U.S. adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356–359.
Deedwania PC: Metabolic syndrome and vascular disease. Is nature or nurture leading the new epidemic of cardiovascular disease? Circulation 2004, 109:2–4. An excellent overview of emerging epidemic of metabolic syndrome and its resultant effects on the cardiovascular risks.
Isomaa B, Almgren P, Tuomi T, et al.: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001, 24:683–689.
Cook S, Witzman M, Auinger P, et al.: Prevalence of a metabolic syndrome phenotype in adolescents. Arch Pediatr Adolesc Med 2003, 157:821–827.
Lakka HM, Laaksonen DE, Lakka TA, et al.: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 25:2709–2716.
Janssen I, Katzmarzyk Ross R: Body mass index, waist circumference and health risk. Arch Intern Med 2002, 162:2074–2079.
Grundy SM, Brewer HB, Cleeman JI, et al.: Definition of metabolic syndrome. Circulation 2004, 109:433–438.
Frayn KN: Adipose tissue and the insulin resistance syndrome. Proc Nutr Soc 2001, 60:375–380.
Yamauchi T, Kamon J, Waki H, et al.: The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 2001, 7:941–946.
Hotta K, Funahashi T, Arita Y, et al.: Plasma concentrations of novel, adipose-specific protein, adiponectin, in type 2 diabetic patients. Arterioscler Thromb Vasc Biol 2000, 20:1595–1599.
Yang WS, Lee WJ, Funahashi T, et al.: Weight reduction increases plasma levels of adipose-derived anti-inflammatory protein, adiponectin. J Clin Endocrinol Metab 2001, 86:2815–2819.
Klein S, Fontana L, Young L, et al.: Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004, 350:2549–2557.
Bonow RO, Eckel RH: Diet, obesity, and cardiovascular risk. N Engl J Med 2003, 348:2057–2058.
van Dam RM, Rimm EB, Willett WC, et al.: Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med 2002, 136:201–209.
Brooks GA, Butte NF, Rand WM, et al.: Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 2004, 79:921S-930S.
Didangelos T, Thanopoulou A, Bousboulas et al.: The orlistat and cardiovascular risk profile inpatients with metabolic syndrome and type 2 diabetes (ORLICARDIA) study. Curr Med Res Opin 2004, 20:1393–1401.
Reaven G: Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 2002, 106:286–288.
DECODE Study Group, European Diabetes Epidemiology Group: Is current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? Diabetes Care 2003, 26:688–696.
Chiasson JL, Josse RG, Gomis R, et al.: Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance. The Stop-NIDDM trial. JAMA 2003, 290:486–494.
Yki-Jarvinen H: Thiazolidinediones. N Engl J Med 2004, 351:1106–1118.
Promrat K, Lutchman G, Uwaifo GI, et al.: A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis. Hepatology 2004, 39:188–196.
Eckel RH: Familial Combined hyperlipidemia and insulin resistance: distant relatives linked by intra-abdominal fat? Arterioscler Thromb Vasc Biol 2001, 21:469–470.
Ballantyne CM, Olsson AG, Cook TJ, et al.: Influence of low high-density lipoprotein cholesterol and elevated triglyceride on coronary heart disease events and response to simvastatin therapy in 4 S. Circulation 2001, 18:3046–3051.
Bravata DM, Sanders L, Huang J, et al.: Efficacy and safety of low-carbohydrate diets: a systemic review. JAMA 2003, 289:1837–1850.
Merritt JC: Metabolic syndrome: soybean foods and serum lipids. J Natl Med Assoc 2004, 96:1032–1041.
Aude YW, Mego P, Mehta J: Metabolic syndrome: dietary interventions. Curr Opin Cardiol 2004, 19:453–459. An excellent summary of dietary interventions based on current evidence in patients with metabolic syndrome.
Sowers JR: Effects of statins on the vasculature: implications for aggressive lipid management in the cardiovascular metabolic syndrome. Am J Cardiol 2003, 91(suppl):14B-22B.
Grundy SM, Cleeman JI, Merz CN, et al.: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004, 110:227–239.
Knopp RH: Drug treatment of lipid disorders. N Engl J Med 1999, 341:498–511.
Cziraky MJ: Management of dyslipidemia in patients with metabolic syndrome. J Am Pharm Assoc 2004, 44:478–488.
Chapman MJ, Assmann G, Fruchart JC, et al.: Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid—a position paper developed by the European Consensus Panel on HDL-C. Curr Med Res Opin 2004, 20:1253–1268.
Dimons L, Tonkon M, Masana L, et al.: Effects of ezetimibe added to on-going stain therapy on lipid profile of hypercholesterolemic patients with diabetes mellitus or metabolic syndrome. Curr Med Res Opin 2004, 20:1437–1445.
Sowers JR, Frohlich ED: Insulin and insulin resistance: impact on blood pressure and cardiovascular disease. Med Clin North Am 2004, 88:63–82. An informative and the most update review of the pathophysiologic mechanisms of metabolic syndrome and its correlation with cardiovascular risk factors.
Sowers JR, Bakris GL: Antihypertensive therapy and the risk of type 2 diabetes mellitus. N Engl J Med 2000, 342:969–970.
Hooper L, Barlett C, Davey SG, et al.: Advice to reduce dietary salt for prevention of cardiovascular disease. Cochrane Database Syst Rev 2004, 2:CD003656.
Vollmer WM, Sacks FM, Ard J, et al.: Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med 2001, 135:1019–1028.
Katovidh MJ, Pachori A: Effects of inhibition of the rennin-angiotensin system of the cardiovascular actions of insulin. Diabetes Obes Metab 2002, 2:3–14.
Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.
Dahlöf B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study: a randomized trial against atenolol. Lancet 2002, 359:995–1003.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators [no authors listed]. Lancet 2000, 355:253–259.
Brenner BM, Cooper ME, De Zeeuw D, et al.: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861–869.
Lewis EJ, Hunsicker LG, Clarke WR, et al.: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001, 354:851–860.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.
Arand SS, Qilong Y, Gerstein H, et al.: Relationship of metabolic syndrome and fibrinolytic dysfunction to cardiovascular disease. Circulation 2003, 108:420–425.
Pearson TA, Blair SN, Daniels SR, et al.: American Heart Association guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular disease. American Heart Association Science Advisory and Coordinating Committee. Circulation 2003, 107:499–511.
Ridker PM, Buring JE, Cook NR, et al.: C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events. An 8-year follow up of 14,719 initially healthy American women. Circulation 2003, 107:391–397.
Feldman M, Jialal I, Devaraj S, et al.: Effects of low-dose aspirin on serum C-reactive protein and thromboxane B2 concentrations: a placebo-controlled study using a highly sensitive C-reactive protein assay. J Am Coll Cardiol 2001, 37:2036–2041.
Dinneen S, Gerstein H: The association of microalbuminuria and mortality in non insulin-dependent diabetes mellitus: a systematic overview of the literature. Arch Intern Med 1997, 157:1413–1418.
Fang J, Alderman MH: Serum uric acid and cardiovascular mortality. JAMA 2000, 283:2404–2410.
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Deedwania, P.C., Volkova, N. Current treatment options for the metabolic syndrome. Curr Treat Options Cardio Med 7, 61–74 (2005). https://doi.org/10.1007/s11936-005-0007-1
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DOI: https://doi.org/10.1007/s11936-005-0007-1