Metabolic syndrome medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Metabolic syndrome is formed by a constellation of [[medicine|medical]] disorders that increases | Metabolic syndrome is formed by a constellation of [[medicine|medical]] disorders that increases the risk of developing [[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== | ==Medical Therapy== | ||
Revision as of 16:51, 2 May 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 the risk of developing 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