Metabolic syndrome medical therapy: Difference between revisions
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{{Metabolic syndrome}} | {{Metabolic syndrome}} | ||
{{CMG}}; | {{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] | ||
==Overview== | ==Overview== | ||
Metabolic syndrome is formed by a constellation of [[medicine|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]].<ref name="pmid15838067">{{cite journal |author=Orchard TJ, Temprosa M, Goldberg R, ''et al.'' |title=The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial |journal=[[Annals of Internal Medicine]] |volume=142 |issue=8 |pages=611–9 |year=2005 |month=April |pmid=15838067 |pmc=2505046 |doi= |url=}}</ref> | |||
* The first line treatment is change of lifestyle (i.e | |||
===Hypertension=== | ===Hypertension=== | ||
* [[BP]] goal- 140/90 or 130/80 in diabetics (JNC 7 guidelines). | |||
* BP goal- 140/90 or 130/80 in diabetics ( | * [[Angiotensin converting enzyme inhibitors]] ([[ACEI]]) and [[angiotensin receptor blocker]]s ([[ARB]]s) should be preferred over [[diuretics]] or [[beta-blockers]] in these patients.<ref name="pmid17964917">{{cite journal| author=Suzuki T, Homma S| title=Treatment of hypertension and other cardiovascular risk factors in patients with metabolic syndrome. | journal=Med Clin North Am | year= 2007 | volume= 91 | issue= 6 | pages= 1211-23, x | pmid=17964917 | doi=10.1016/j.mcna.2007.06.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17964917 }} </ref> | ||
* [[Angiotensin converting enzyme inhibitors]] (ACEI) and [[angiotensin receptor blocker]]s ( | |||
===Elevated low-density lipoprotein cholesterol (LDL-C)=== | ===Elevated low-density lipoprotein cholesterol (LDL-C)=== | ||
* The goal is to get the [[LDL]] down to < 100 mg/dl. | * The goal is to get the [[LDL]] down to < 100 mg/dl. | ||
* [[Statin]]s are | * [[Statin]]s are the drugs of choice. | ||
* | * However, [[statin]]s are contraindicated in [[pregnancy]]. | ||
===Decreased high-density lipoprotein cholesterol (HDL-C)=== | ===Decreased high-density lipoprotein cholesterol ([[HDL]]-C)=== | ||
* [[Diet]] (decreased calorie intakes) | |||
* Diet (decreased calorie intakes) | * Increased [[physical activity]] | ||
* Increased physical activity | |||
* [[Niacin]] | * [[Niacin]] | ||
* [[Cholesteryl ester transfer protein]] (CETP) inhibitors ([[torcetrapib]]) and ([[anacetrapib]]) are | * [[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]] | * [[Fibric acid]] | ||
* [[Niacin]] | * [[Niacin]] (however at higher doses (>1500 mg/d) it may exacerbate [[hyperglycemia]]) <ref name="pmid14742767">{{cite journal| author=Ito MK| title=The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin. | journal=Ann Pharmacother | year= 2004 | volume= 38 | issue= 2 | pages= 277-85 | pmid=14742767 | doi=10.1345/aph.1D218 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14742767 }} </ref> | ||
* Addition of [[omega-3 fatty acid]]s also produces beneficial effects. | * Addition of [[omega-3 fatty acid]]s also produces beneficial effects. | ||
===Diabetes=== | ===Diabetes=== | ||
* Use of drugs that decrease [[insulin resistance]] e.g., [[metformin]].<ref name="pmid15838067">{{cite journal| author=Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S et al.| title=The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 8 | pages= 611-9 | pmid=15838067 | doi= | pmc=PMC2505046 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15838067 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16262224 Review in: ACP J Club. 2005 Nov-Dec;143(3):67] </ref> <ref name="pmid9742977">{{cite journal |author= |title=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 |journal=[[Lancet]] |volume=352 |issue=9131 |pages=854–65 |year=1998 |month=September |pmid=9742977 |doi= |url=}}</ref> Use of [[thiazolidinedione]]s is controversial and not FDA approved.<ref name="pmid16873813">{{cite journal |author=Nathan DM, Buse JB, Davidson MB, ''et al.'' |title=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 |journal=[[Diabetes Care]] |volume=29 |issue=8 |pages=1963–72 |year=2006 |month=August |pmid=16873813 |doi=10.2337/dc06-9912 |url=}}</ref> | |||
* | ===Cardiovascular Risk=== | ||
* [[Aspirin]] therapy may be helpful in the primary prevention of [[cardiovascular]] complications.<ref name="pmid22311905">{{cite journal |author=Smith JP, Haddad EV, Taylor MB, ''et al.'' |title=Suboptimal inhibition of platelet cyclooxygenase-1 by aspirin in metabolic syndrome |journal=[[Hypertension]] |volume=59 |issue=3 |pages=719–25 |year=2012 |month=March |pmid=22311905 |pmc=3418792 |doi=10.1161/HYPERTENSIONAHA.111.181404 |url=}}</ref> | |||
== | ==Supportive Trial Data== | ||
===Study on the effects of metformin and life-style changes on the incidence of metabolic syndrome <ref name="pmid15838067">{{cite journal| author=Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S et al.| title=The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 8 | pages= 611-9 | pmid=15838067 | doi= | pmc=PMC2505046 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15838067 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16262224 Review in: ACP J Club. 2005 Nov-Dec;143(3):67] </ref>=== | ===Study on the effects of metformin and life-style changes on the incidence of metabolic syndrome <ref name="pmid15838067">{{cite journal| author=Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S et al.| title=The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. | journal=Ann Intern Med | year= 2005 | volume= 142 | issue= 8 | pages= 611-9 | pmid=15838067 | doi= | pmc=PMC2505046 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15838067 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16262224 Review in: ACP J Club. 2005 Nov-Dec;143(3):67] </ref>=== | ||
* 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 | ** 53% of participants (n = 1711) had metabolic syndrome at baseline | ||
* Results of Log-rank test | ** 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. | ** 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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WS}} | |||
{{WH}} | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
Latest revision as of 16:21, 20 September 2017
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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)