Metabolic syndrome medical therapy
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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.
Treatment
- 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.
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 in trial stages and their benefits in increasing HDL levels are yet to be proved.
Elevated Triglyceride
- Fibric acid
- Niacin {however at higher doses (>1500 mg/d) it may exacerbate hyperglycemia}
- Addition of omega-3 fatty acids also produces beneficial effects.
Diabetes
- Use of drugs that decrease insulin resistance e.g., metformin. Use of thiazolidinediones is controversial and not FDA approved.
Cardiovascular risk
- Aspirin therapy may be helpful in the primary prevention of cardiovascular complications