Diagnosis, prevention, and intervention for the metabolic syndrome

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Abstract

The term metabolic syndrome refers to a virulent and lethal group of atherosclerotic risk factors, including dyslipidemia, insulin resistance, obesity, and hypertension. This syndrome affects some 47 million people in the United States, placing them at increased risk for coronary artery disease (CAD). Particularly prominent as a risk factor for development of heart disease is central obesity. Immediate treatment of the metabolic syndrome is essential because these patients quickly develop diabetes, CAD, and stroke. Treatment is a multifactorial process and includes diet, exercise, and pharmacologic therapy. The latter consists of statins, fibrates, angiotensin-converting enzyme inhibitors, and thiazolidinediones, all of which can decrease the risk and incidence of CAD.

Section snippets

Prevalence

Without a unifying definition, reports of prevalence have varied in the United States and Europe.7, 8 Using the WHO definition and data from the National Health and Nutrition Examination Survey III (NHANES III) and the ATP III criteria, the age-adjusted prevalence of the metabolic syndrome in the US population is now estimated at 23.7% and increases to 43.5% in adults who are ≥60 years of age. African American and Mexican American women have significantly higher prevalence rates than do their

Features of the metabolic syndrome

The presence of abdominal obesity in subjects with IR is a powerful risk factor for the development of type 2 diabetes mellitus and cardiovascular disease.11, 12, 13, 14 Excessive visceral adipose tissue accumulation (in the presence or absence of obesity) is associated with IR, hyperinsulinemia, and glucose intolerance.15, 16, 17, 18 In addition, excess abdominal obesity is associated with a potentially atherogenic lipoprotein profile, which includes (1) hypertriglyceridemia; (2) elevated

Treating the metabolic syndrome

When a patient with metabolic syndrome is identified, the health care provider must effectively communicate the significant risk of developing overt type 2 diabetes mellitus, CAD, and stroke. The patient needs to understand that type 2 diabetes mellitus is a CAD risk equivalent.

The primary goals of treating metabolic syndrome are prevention of type 2 diabetes mellitus and cardiovascular events. According to the American Diabetes Association and the ATP III, the starting point for treatment is

Conclusion

Challenges clinicians encounter with the metabolic syndrome are early detection of IR and implementation of treatment strategies that encompass all components of the metabolic syndrome. A shift in focus in the diagnosis and treatment of the metabolic syndrome from glucose control to primary prevention, early detection, and treatment of the underlying atherogenic risk factors is needed to prevent the progression of type 2 diabetes mellitus and cardiovascular disease.

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