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Query: UMLS:C0948265 (metabolic syndrome)
 24,271 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease (CVD), which includes myocardial infarction(MI), stroke, and peripheral vascular disease, remains the leading cause of death in the United States and in most developed countries. In the United States today, 25% of patients have metabolic syndrome-including those who have had a prior occlusive vascular disease event, those who are having an acute MI or ischemic stroke, and finally, the largest segment of the population,namely those who have not yet experienced a clinical CVD, but whose risks are substantial (10-year risk 10%). This article reviews the totality of evidence for aspirin in the treatment and prevention of CVD and emphasizes its importance as adjunctive therapy for patients with metabolic syndrome.
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PMID:Management of metabolic syndrome: aspirin. 1526 98

Hyperlipidaemia is a pivotal risk factor for the development of atherosclerotic disease. A large number of studies have demonstrated that the treatment of abnormalities in lipoprotein levels reduces the risk for myocardial infarction, peripheral vascular disease, carotid artery disease, stroke, and cardiovascular mortality. Despite the development of multiple drug classes to treat dyslipidaemias and the promulgation of clearly defined guidelines for the management of lipid disorders, dyslipidaemia tends to be undertreated in the majority of patients at risk for cardiovascular disease. A part of the reluctance to treat different lipoprotein fractions to goal levels is attributable to physician- and patient-related concerns over the increasing toxicity of available therapies, as their dosages are increased. The risks of hepatotoxicity, myalgia, and rhabdomyolysis are fairly well characterised in patients receiving statins, fibrates and niacin. Another issue affecting treatment success rates is the fact that many patients with complex dyslipidaemias are inadequately responsive to single-agent therapy. As the epidemics of obesity, metabolic syndrome and diabetes mellitus continue to worsen, physicians will encounter severe, mixed dyslipidaemias more frequently. Many of these patients will require combinations of drugs to address the various metabolic derangements causing changes in multiple lipoprotein fractions. Although the need for combination therapy is well-established in the management of disorders, such as hypertension and diabetes, it is less often used for the treatment of dyslipidaemias. The development of safe, cost-effective, and efficacious combination dyslipidaemic therapy is an important goal in cardiovascular medicine. Simvastatin plus ezetimibe has recently been combined as a fixed dose therapy, which offers clinicians the opportunity to simultaneously inhibit two key pathways in cholesterol metabolism: hepatic cholesterol biosynthesis and the absorption of cholesterol at the level of the proximal jejunum. This dual mechanism of inhibition substantially increases the capacity to decrease serum levels of atherogenic low-density lipoproteins and increase high-density lipoprotein, compared with that observed when either drug is used alone. This combination increases the likelihood of therapeutic success in patients with dyslipidaemia.
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PMID:Simvastatin plus ezetimibe: combination therapy for the management of dyslipidaemia. 1570 90

Peripheral vascular disease (PVD) is very prevalent in the United States and is part of a global vascular problem. PVD patients have a heightened inflammatory state and are at high risk of death from acute cardiovascular problems rather than from progression of PVD. Modifiable risk factors for PVD include smoking, hypertension, diabetes, hyperlipidemia, elevated high sensitivity C-reactive protein, obesity, and the metabolic syndrome. Symptomatic treatment of claudication includes smoking cessation, exercise, cilostazol, statins, and revascularization with percutaneous or surgical therapy. Antithrombotic therapy with aspirin or clopidogrel is important to reduce cardiovascular events but does not affect symptoms of claudication. Patients with rest limb ischemia or ulceration should be revascularized to minimize the chance of limb loss. Percutaneous revascularization is not without significant complications, however, and future research needs to focus on inflammation, thrombosis, and restenosis in the PVD patient. Finally, new devices that tackle difficult lesions, drug-eluting stents, and pharmacologic agents that reduce global atherosclerosis are on the horizon and are likely to become critical components in the management of the PVD patient.
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PMID:Evidence-based management of peripheral vascular disease. 1610 78

Cardiovascular disease remains a leading cause of death throughout the world despite advances in its detection and treatment. Commonly used risk algorithms, such as the Framingham Risk Score fail to identify all affected individuals. Novel cardiovascular risk factors that identify these missed individuals would greatly improve overall care of patients. C-reactive protein (CRP), an inflammatory biomarker, has emerged as a leading candidate to fulfill this role. Based on the results of several prospective epidemiologic studies, CRP has emerged as one of the most powerful predictors of cardiovascular disease. This marker provides valuable information to clinicians in various clinical settings, ranging from overt cardiovascular disease, stable angina, presenting acute coronary syndromes and peripheral vascular disease, to the metabolic syndrome. Furthermore, CRP has been demonstrated to actively contribute to all stages of atherogenesis, participating in endothelial dysfunction, atherosclerotic-plaque formation, plaque maturation, plaque destabilization and eventual rupture. Thus, it might also serve as a therapeutic target. It is our contention that the future will see much wider use of CRP and CRP-driven therapies in clinical medicine, improving our ability to identify and manage cardiovascular disease.
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PMID:C-reactive protein comes of age. 1626 40

The aim was to compare in patients with type 2 diabetes mellitus (DM2) the prevalence of the metabolic syndrome according to the World Health Organization (WHO) and the National Cholesterol Education Program (NCEP) definitions, and to analyze the association between them and the complications of DM2. Patients with DM2 (n= 753) were evaluated for ethnics, anthropometrics and laboratory parameters and for the presence of DM2 complications: diabetic nephropathy, coronary artery disease, stroke, diabetic retinopathy and peripheral vascular disease. Insulin resistance was estimated using the HOMA index. Metabolic syndrome was found in 671 (89%) and 657 (87%) patients using the WHO definition and the NCEP definition, respectively. In the total group, there was a moderate agreement between the two definitions (k= 0.54; 95% CI 0.49-0.59), although, it was better for black patients (k= 0.69; 95% CI 0.60-0.78) than white (k= 0.54; 95% CI 0.48-0.6) or mulattos patients (k= 0.26; 95% CI 0.09-0.43). Patients with metabolic syndrome using the NCEP criteria had higher HOMA-IR values compared to those without metabolic syndrome (p= 0.001). This differentiation was not seen using the WHO definition (p= 0.152). The proportion of diabetic complications was similar for both definitions. In conclusion, regarding the risk of diabetic complications both definitions are equivalent. However, there are some ethnic differences in the agreement between the two definitions.
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PMID:[Analysis of the criteria used for the definition of metabolic syndrome in patients with type 2 diabetes mellitus]. 1676 92

Cardiovascular disease is the leading cause of death in women in most developed countries of the world. Even though cardiovascular deaths of men in the United States have been declining, until recently the number of cardiovascular deaths in US women was on the rise, with 1 in 3 women dying from heart disease. Over the last 30 years numerous studies have reported sex differences in the epidemiology, prevention, diagnosis, and clinical manifestations of coronary artery disease. A higher morbidity and mortality were also noted in women versus men undergoing revascularization during this early period. This has mainly been attributed to the fact that women have more comorbid conditions by the time that they are referred for revascularization. These conditions include increased age, hypertension, diabetes (metabolic syndrome), heart failure, renal disease, peripheral vascular disease, and worse lipid profile. With improvements of both surgical techniques and percutaneous coronary intervention, morbidity and mortality rates have decreased in women undergoing revascularization. However, there are now questions surrounding percutaneous coronary intervention strategies, particularly with drug eluting stents. More recent advances in coronary bypass graft surgery techniques, both off- and on-pump, and analysis of prospective and retrospective data have shown a clearly improved survival rate in patients undergoing coronary bypass graft surgery and the persistence of a durable result.
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PMID:Confusion in revascularization: are women different and why? 1809

The significance of the metabolic syndrome in type 1 diabetes is not well understood. This study aimed to estimate its prevalence and attendant complications. Four hundred twenty-seven type 1 diabetic subjects were grouped according to the presence or absence of metabolic syndrome (WHO criteria). Macro- and microvascular complications were compared between the groups as individual and as composite endpoints. Data were analyzed for the total cohort and in subgroups according to duration of diabetes quartiles (<6.9, 7-12.9, 13-19.9, and >20 years) and year of presentation. Fifteen percent of individuals fulfilled the WHO criteria for metabolic syndrome, and of these, 26.9% were insulin resistant, as compared with 3.4% of those without metabolic syndrome [odds ratio (OR)=8.9, P=.001]. Both BMI and metabolic syndrome showed an increasing trend from 1992 to 2003. Those with metabolic syndrome required significantly higher insulin dosage [0.9 (0.7-1.2) vs. 0.6 (0.5-0.9) units/kg, P=.03], were older [35.0 (26.2-47.3) vs. 29.7 (23.4-36.4) years, P=.002], and had longer duration of diabetes [19.7 (10.7-25.6) vs. 12.1 (6.3-17.9) years, P=.0001]. They also had a significantly higher macrovascular composite endpoint (OR=3.3, P=.02) as well as higher macrovascular and microvascular composite endpoint (OR=3.1, P=.0001). The prevalence of stroke (OR=22.8, P=.008), peripheral vascular disease (OR=7.3, P=.05), and severe retinopathy (OR=3.7, P=.01) is higher in subjects with metabolic syndrome in the >or=20-year quartile group; in addition, these subjects have higher macrovascular composite endpoint (OR=3.9, P=.03) and macrovascular and microvascular composite endpoint (OR=2.9, P=.03). This remained so even when subjects with albuminuria were excluded. Some individuals with type 1 diabetes can also have metabolic syndrome. They are more prone to complications and require even more intensive glycemic control and reduction of macrovascular risk factors.
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PMID:The metabolic syndrome in type 1 diabetes: does it exist and does it matter? 1819 Oct 73

Metabolic syndrome (MS), which is composed of such factors as hyperinsulinemia, insulin resistance, glucose intolerance, abdominal obesity, arterial hypertension, and dyslipidemia, contributes to accelerated development of atherosclerosis, coronary artery disease, and type 2 diabetes. It has thus become one of the major public-health challenges worldwide. The primary goal of its clinical management is to reduce the risk for cardiovascular diseases related to atherosclerosis, especially myocardial infarction, stroke, and peripheral vascular disease, and to lower the risk for type 2 diabetes. The fi rst stage in its successful preventive management is identification of the population at high risk of developing metabolic syndrome. The therapeutic approach to metabolic syndrome consists fi rst of all of lifestyle modification, i.e. the introduction of a low calorie diet, weight reduction, and regular physical activity. For people at high risk for cardiovascular diseases and type 2 diabetes as well as those with coronary artery disease and/or type 2 diabetes, pharmacological therapy should be considered. Pharmacological management must address the multipathological process of metabolic syndrome, with each component identified and properly treated. Current therapies for metabolic syndrome treat fi rst of all obesity, insulin resistance, dyslipidemia, and hypertension. The pharmacological agents most often suggested are those which increase insulin resistance (metformin and thiazolidinediones). Among the medications used in metabolic syndrome therapy are also fibrates and statins for atherogenic dyslipidemia and those lowering blood pressure, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. This review presents the most important aspects of the prevention and treatment of patients with metabolic syndrome, including new therapeutic strategies.
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PMID:[Metabolic syndrome. Part III: its prevention and therapeutic management]. 1893 31

The CD40/CD40 ligand plays a role in the inflammatory and prothrombotic processes in atherosclerosis. We analyzed whether short-term treatment with atorvastatin affects soluble CD40 ligand (sCD40L) plasma levels in subjects at high cardiovascular risk. sCD40L plasma concentrations were measured in 852 subjects from the Atorvastatin on Inflammatory Markers (AIM) Study, a 12-week prospective multicenter, open-label trial which enrolled statin-free subjects with coronary heart disease (CHD), CHD-equivalent (diabetes, peripheral vascular disease, or cerebrovascular disease), or a 10-year CHD risk >20%. Subjects were assigned to atorvastatin (10-80 mg/day) based on LDL-C at screening. Overall, sCD40L levels were not different in patients at high cardiovascular risk compared with healthy subjects. When sCD40L levels were divided in quartiles, patients in the highest quartile (N=213) had higher sCD40L concentrations than age- and gender-matched healthy subjects (N=29) (P<0.0001). Interestingly, all doses of atorvastatin significantly diminished sCD40L levels in subjects at the highest quartile. Furthermore, atorvastatin treatment decreased sCD40L more markedly in subjects with metabolic syndrome compared with those without metabolic syndrome. In conclusion, atorvastatin diminishes sCD40L plasma levels, more markedly so in subjects with metabolic syndrome. Our results indicate that short-term treatment with atorvastatin exhibits anti-inflammatory and antithrombotic effects in subjects at high cardiovascular risk.
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PMID:Atorvastatin decreases elevated soluble CD40L in subjects at high cardiovascular risk. Atorvastatin on inflammatory markers study: a substudy of ACTFAST. 1903 29

The metabolic syndrome is associated with elevated peripheral vascular disease risk, characterized by mismatched blood flow delivery/distribution and local metabolism. The obese Zucker rat (OZR) model of the metabolic syndrome exhibits myriad vascular impairments, although their integrated impact on functional hyperaemia remains unclear. In this study, arterial pressor responses and skeletal muscle perfusion were assessed in lean Zucker rats (LZRs) and OZRs during adrenergic stimulation (phenylephrine), challenge with thromboxane (U46619) and endothelium-dependent dilatation (methacholine). The OZRs were hypertensive compared with the LZRs, but this was abolished by adrenoreceptor blockade (phentolamine); pressor responses to U46619 were similar between strains and were abolished by blockade with the prostaglandin H(2)/thromboxane A(2) receptor antagonist, SQ-29548. Depressor reactivity to methacholine was impaired in OZRs, but was improved by antioxidant treatment (TEMPOL). Across levels of metabolic demand, blood flow to in situ gastrocnemius muscle was restrained by adrenergic constriction in OZRs, although this diminished with increased demand. Oxygen extraction, reduced in OZRs compared with LZRs across levels of metabolic demand, was improved by TEMPOL or SQ-29548; treatment with phentolamine did not impact extraction, and neither TEMPOL nor SQ-29548 improved muscle blood flow in OZRs. While oxygen uptake and muscle performance were consistently reduced in OZRs versus LZRs, treatment with all three agents improved outcomes, while treatment with individual agents was less effective. These results suggest that contributions of vascular dysfunction to perfusion, oxygen uptake and muscle performance are spatially distinct, with adrenergic constriction impacting proximal resistance and endothelial dysfunction impacting distal microvessel-tissue exchange. Further, these data suggest that increasing skeletal muscle blood flow in OZRs is not sufficient to improve performance, unless distal perfusion inhomogeneities are rectified.
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PMID:Divergence between arterial perfusion and fatigue resistance in skeletal muscle in the metabolic syndrome. 2112 63


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