Metabolic syndrome medical therapy

	Metabolic syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Metabolic Syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Dietary Therapy
Physical Activity
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Tertiary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Metabolic syndrome medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Metabolic syndrome medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Metabolic syndrome medical therapy
CDC on Metabolic syndrome medical therapy
Metabolic syndrome medical therapy in the news
Blogs on Metabolic syndrome medical therapy
Directions to Hospitals Treating Metabolic syndrome
Risk calculators and risk factors for Metabolic syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

Metabolic syndrome is formed by a constellation of medical disorders that increases the risk of developing cardiovascular disease and diabetes mellitus. It affects a large number of people in a clustered fashion. Management of metabolic syndrome involves dietary modifications, exercise and drug therapy for the complications (diabetes, stroke, angina, myocardial infarction) found associated with these conditions.

Medical Therapy

The first line of treatment is a change of lifestyle (i.e, caloric restriction, physical activity, weight loss). However, drug treatment is frequently required to prevent complications of metabolic syndrome.^[1]

Hypertension

BP goal- 140/90 or 130/80 in diabetics (JNC 7 guidelines).
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) should be preferred over diuretics or beta-blockers in these patients.^[2]

Elevated low-density lipoprotein cholesterol (LDL-C)

The goal is to get the LDL down to < 100 mg/dl.
Statins are the drugs of choice.
However, statins are contraindicated in pregnancy.

Decreased high-density lipoprotein cholesterol (HDL-C)

Diet (decreased calorie intakes)
Increased physical activity
Niacin
Cholesteryl ester transfer protein (CETP) inhibitors (torcetrapib) and (anacetrapib) are currently investigational agents and the clinical benefits associated with the documented raising of HDL levels are unproven.

Elevated Triglycerides

Fibric acid
Niacin (however at higher doses (>1500 mg/d) it may exacerbate hyperglycemia) ^[3]
Addition of omega-3 fatty acids also produces beneficial effects.

Diabetes

Use of drugs that decrease insulin resistance e.g., metformin.^[1] ^[4] Use of thiazolidinediones is controversial and not FDA approved.^[5]

Cardiovascular Risk

Aspirin therapy may be helpful in the primary prevention of cardiovascular complications.^[6]

Supportive Trial Data

Study on the effects of metformin and life-style changes on the incidence of metabolic syndrome ^[1]

SOURCE and YEAR: Ann Intern Med. 2005

OBJECTIVE: The effect of intensive lifestyle intervention and metformin therapy on the syndrome's incidence and resolution

METHOD: Randomized controlled trial

STUDY POPULATION: 1711 participants

STUDY PERIOD: 3.2 years

INTERVENTIONS: Metformin, 850 mg twice daily, or intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week.

RESULTS:
- 53% of participants (n = 1711) had metabolic syndrome at baseline
- Results of Log-rank test
- Incidence of the metabolic syndrome was reduced by 41% in the lifestyle group (P < 0.001) and by 17% in the metformin group (P = 0.03) compared with placebo.
- 3 year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively.

CONCLUSION: Lifestyle intervention and metformin therapy reduces the development of metabolic syndrome.

References

↑ ^1.0 ^1.1 ^1.2 Orchard TJ, Temprosa M, Goldberg R; et al. (2005). "The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial". Annals of Internal Medicine. 142 (8): 611–9. PMC 2505046. PMID 15838067. Unknown parameter |month= ignored (help)
↑ Suzuki T, Homma S (2007). "Treatment of hypertension and other cardiovascular risk factors in patients with metabolic syndrome". Med Clin North Am. 91 (6): 1211–23, x. doi:10.1016/j.mcna.2007.06.009. PMID 17964917.
↑ Ito MK (2004). "The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin". Ann Pharmacother. 38 (2): 277–85. doi:10.1345/aph.1D218. PMID 14742767.
↑ "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group". Lancet. 352 (9131): 854–65. 1998. PMID 9742977. Unknown parameter |month= ignored (help)
↑ Nathan DM, Buse JB, Davidson MB; et al. (2006). "Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes". Diabetes Care. 29 (8): 1963–72. doi:10.2337/dc06-9912. PMID 16873813. Unknown parameter |month= ignored (help)
↑ Smith JP, Haddad EV, Taylor MB; et al. (2012). "Suboptimal inhibition of platelet cyclooxygenase-1 by aspirin in metabolic syndrome". Hypertension. 59 (3): 719–25. doi:10.1161/HYPERTENSIONAHA.111.181404. PMC 3418792. PMID 22311905. Unknown parameter |month= ignored (help)

Template:WS Template:WH

[pmid15838067-1] 1.0 ^1.1 ^1.2 Orchard TJ, Temprosa M, Goldberg R; et al. (2005). "The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial". Annals of Internal Medicine. 142 (8): 611–9. PMC 2505046. PMID 15838067. Unknown parameter |month= ignored (help)

[pmid17964917-2] Suzuki T, Homma S (2007). "Treatment of hypertension and other cardiovascular risk factors in patients with metabolic syndrome". Med Clin North Am. 91 (6): 1211–23, x. doi:10.1016/j.mcna.2007.06.009. PMID 17964917.

[pmid14742767-3] Ito MK (2004). "The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin". Ann Pharmacother. 38 (2): 277–85. doi:10.1345/aph.1D218. PMID 14742767.

[pmid9742977-4] "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group". Lancet. 352 (9131): 854–65. 1998. PMID 9742977. Unknown parameter |month= ignored (help)

[pmid16873813-5] Nathan DM, Buse JB, Davidson MB; et al. (2006). "Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes". Diabetes Care. 29 (8): 1963–72. doi:10.2337/dc06-9912. PMID 16873813. Unknown parameter |month= ignored (help)

[pmid22311905-6] Smith JP, Haddad EV, Taylor MB; et al. (2012). "Suboptimal inhibition of platelet cyclooxygenase-1 by aspirin in metabolic syndrome". Hypertension. 59 (3): 719–25. doi:10.1161/HYPERTENSIONAHA.111.181404. PMC 3418792. PMID 22311905. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

[4]

[5]

[6]