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'''Metabolic syndrome''' is formed by a constellation of [[medicine|medical]] disorders that increases one's risk for [[cardiovascular disease]] and [[Diabetes mellitus|diabetes]]. It effects 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. | '''Metabolic syndrome''' is formed by a constellation of [[medicine|medical]] disorders that increases one's risk for [[cardiovascular disease]] and [[Diabetes mellitus|diabetes]]. It effects 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 treatment is change of lifestyle (i.e., caloric restriction, physical activity, weight loss). However, drug treatment is frequently required for complications that are seen with them. | * The first line treatment is change of lifestyle (i.e., caloric restriction, physical activity, weight loss). However, drug treatment is frequently required for complications that are seen with them. | ||
===Hypertension=== | ===Hypertension=== | ||
* BP goal- 140/90 or 130/80 in diabetics ([[JNC 7]] guidelines). | * BP goal- 140/90 or 130/80 in diabetics ([[JNC 7]] guidelines). | ||
* [[Angiotensin converting enzyme inhibitors]] (ACEI) and [[angiotensin receptor blocker]]s (ARBs) 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 (ARBs) 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>. | ||
===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 drug of choice. | * [[Statin]]s are drug of choice. | ||
* Statins are however contraindicated in [[pregnancy]]. | * Statins are however 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 | ||
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===Elevated Triglycerides=== | ===Elevated Triglycerides=== | ||
* [[Fibric acid]] | * [[Fibric acid]] | ||
* [[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> | * [[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> | ||
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===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>. Use of [[thiazolidinedione]]s is controversial and not FDA approved. | * 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>. Use of [[thiazolidinedione]]s is controversial and not FDA approved. | ||
===Cardiovascular | ===Cardiovascular Risk=== | ||
* [[Aspirin]] therapy may be helpful in the primary prevention of cardiovascular complications. | * [[Aspirin]] therapy may be helpful in the primary prevention of cardiovascular complications. | ||
==Trial | ==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. | ||
** 3year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively. | ** 3year 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== | ||
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[[Category:Metabolic disorders]] | [[Category:Metabolic disorders]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Syndromes]] | [[Category:Syndromes]] | ||
[[Category: | [[Category:Disease]] | ||
Revision as of 20:03, 29 April 2013
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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 one's risk for cardiovascular disease and diabetes. It effects 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 treatment is change of lifestyle (i.e., caloric restriction, physical activity, weight loss). However, drug treatment is frequently required for complications that are seen with them.
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 [1].
Elevated low-density lipoprotein cholesterol (LDL-C)
- The goal is to get the LDL down to < 100 mg/dl.
- Statins are drug of choice.
- Statins are however 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) [2]
- Addition of omega-3 fatty acids also produces beneficial effects.
Diabetes
- Use of drugs that decrease insulin resistance e.g., metformin [3]. Use of thiazolidinediones is controversial and not FDA approved.
Cardiovascular Risk
- Aspirin therapy may be helpful in the primary prevention of cardiovascular complications.
Supportive Trial Data
Study on the effects of metformin and life-style changes on the incidence of metabolic syndrome [3]
- 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.
- 3year 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
- ↑ 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.
- ↑ 3.0 3.1 Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S; et al. (2005). "The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial". Ann Intern Med. 142 (8): 611–9. PMC 2505046. PMID 15838067. Review in: ACP J Club. 2005 Nov-Dec;143(3):67