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Query: UMLS:C0948265 (metabolic syndrome)
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The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published. These trials addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy. The present document reviews the results of these recent trials and assesses their implications for cholesterol management. Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management. The trials confirm the benefit of cholesterol-lowering therapy in high-risk patients and support the ATP III treatment goal of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL. They support the inclusion of patients with diabetes in the high-risk category and confirm the benefits of LDL-lowering therapy in these patients. They further confirm that older persons benefit from therapeutic lowering of LDL-C. The major recommendations for modifications to footnote the ATP III treatment algorithm are the following. In high-risk persons, the recommended LDL-C goal is <100 mg/dL, but when risk is very high, an LDL-C goal of <70 mg/dL is a therapeutic option, ie, a reasonable clinical strategy, on the basis of available clinical trial evidence. This therapeutic option extends also to patients at very high risk who have a baseline LDL-C < 100 mg/dL. Moreover, when a high-risk patient has high triglycerides or low high-density lipoprotein cholesterol (HDL-C), consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. For moderately high-risk persons (2+ risk factors and 10-year risk 10% to 20%), the recommended LDL-C goal is <130 mg/dL, but an LDL-C goal <100 mg/dL is a therapeutic option on the basis of recent trial evidence. The latter option extends also to moderately high-risk persons with a baseline LDL-C of 100 to 129 mg/dL. When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels. Moreover, any person at high risk or moderately high risk who has lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglycerides, low HDL-C, or metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C level. Finally, for people in lower-risk categories, recent clinical trials do not modify the goals and cutpoints of therapy.
J Am Coll Cardiol 2004 Aug 04
PMID:Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. 1535 46

A unified definition of metabolic syndrome, considered a common feature of cardiovascular risk, is lacking. The aim of this study was to compare the prevalence of this syndrome in patients with ischemic heart disease using two diagnostic criteria: the European Group of Resistance to Insulin and the National Cholesterol Education Program. We designed an observational, cross-sectional study of the factors that make up metabolic syndrome in subjects diagnosed with coronary heart disease. A total of 169 patients aged 35 to 79 years were studied (129 men and 40 women). With the European group criterion the percentage of patients with metabolic syndrome was 43.7%, whereas the American group criterion yielded a prevalence of 40.8% (no significant difference). The prevalence of metabolic syndrome among patients with ischemic heart disease is high. The diagnostic criteria used are similar and do not differ significantly, although diagnostic concordance was only 50%.
Rev Esp Cardiol 2004 Sep
PMID:[Metabolic syndrome in patients with coronary heart disease. Results of using different diagnostic criteria]. 1537 96

The metabolic syndrome is a widespread clinical condition and an important cluster of atherothrombotic disease risk factors. The inclusion of this syndrome in the recently published Adult Treatment Panel III (ATP III) guidelines focused the attention of the physicians on this entity. Abdominal obesity, PPAR modulation, insulin resistance (with or without glucose intolerance), atherogenic dyslipidemia, elevated blood pressure, prothrombotic and proinflammatory states are the principal factors of this multifaceted syndrome. There are two major pathways of metabolic syndrome progress: (1) With preserved pancreatic beta cells function and insulin hypersecretion, which can recompense for insulin resistance. This pathway leads mostly to the macrovascular complications of metabolic syndrome. (2) With substantial injure of pancreatic beta cells leading to gradually reduced insulin secretion and to hyperglycemia (e.g. overt type 2 diabetes). This pathway leads to both microvascular and macrovascular complications. Because macrovascular complications of insulin resistance state precede the onset of hyperglycemia, early intervention in patients with metabolic syndrome is particularly important. Since central obesity (accompanied by insulin resistance even in the absence of hyperglycemia) is the key factor leading to development of metabolic syndrome and its future macrovascular complications, we assume that next logical step is the recognition of central obesity itself as a major risk factor for cardiovascular diseases.
Int J Cardiol 2004 Nov
PMID:Macrovascular complications of metabolic syndrome: an early intervention is imperative. 1545 79

The metabolic syndrome is a highly prevalent condition in the United States and it has been estimated from the Third National Health and Nutrition Examination Survey that approximately 40 million individuals fulfill the diagnostic criteria, which include a waist circumference greater than 40 inches in men and 35 inches in women, triglycerides in excess of 150 mg/dL, and a high-density lipoprotein cholesterol under 40 mg/dL in men or under 50 mg/dL in women. Additionally, a blood pressure in excess of 130/85 mm Hg and a fasting plasma glucose above 110 mg/dL is required. The diagnosis of the metabolic syndrome requires at least three of the five major criteria for qualification. Hypertension, dyslipidemia, and diabetes frequently cluster and share common pathogenetic mechanisms, resulting in a complex interplay between these apparently disparate risk factors. This review centers on the common metabolic pathways that are common to the major conditions seen in the metabolic syndrome, and centers on the central role of hypertension and the clinical impact of drug therapy on other metabolic parameters.
Curr Cardiol Rep 2004 Nov
PMID:Hypertension and the metabolic syndrome. 1548 2

As we enter the twenty-first century, the burden of chronic diseases, such as obesity, type 2 diabetes, and CVDs, is expected to increase dramatically. These diseases are a consequence of several factors that include an aging population,changes in demographic composition, and an excess of contemporary lifestyle. The prevention and control of overweight, obesity, metabolic syndrome, and diabetes pose special challenges for clinical and public heath practice as well as for basic, clinical, and population science research.
Cardiol Clin 2004 Nov
PMID:Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. 1550 18

Diabetes and the metabolic syndrome, including insulin resistance, that underlies it are hyper-coagulable states. Increased platelet reactivity,augmented activity of the coagulation system,and impaired fibrinolysis are characteristic and understood to a remarkable extent. In aggregate,these derangements contribute to accelerated atherosclerosis, premature coronary artery dis-ease, and a profound toll from both.
Cardiol Clin 2004 Nov
PMID:Platelet function, coagulopathy, and impaired fibrinolysis in diabetes. 1550 20

The prevalence of diabetes in the United States is on the rise because of changing characteristics of our population. Ours is an aging population; women who are older than 75 years constitute the fastest growing segment of our population. Our population is increasingly more overweight and sedentary and the numbers of minority persons who have a higher prevalence of obesity and diabetes are on the rise. Currently, at least 17 million persons have known diabetes; another 4 million have the disease but have not been diagnosed. There also is a much larger population-perhaps up to 60 million per-sons-who has the metabolic syndrome. Up to 60% of persons who have essential hypertension have impaired insulin resistance and other characteristics of this syndrome. This article focuses on the metabolic syndrome and diabetes in women and the elderly.
Cardiol Clin 2004 Nov
PMID:Diabetes in the elderly and in women: cardiovascular risks. 1550 22

Exercise training is an essential component in the medical management of patients who have type 2 diabetes and hypertension. Regular exercise improves the cardiovascular health of individuals who have these conditions through multiple mechanisms (Fig. 1). These mechanisms include improvements in endothelial vasodilator function,left ventricular diastolic function, arterial stiffness.systematic inflammation, and reducing left ventricular mass. Exercise training also reduces total and abdominal fat, which mediate improvements in insulin sensitivity and blood pressure, and possibly, endothelial function. Persons who are in a prediabetic stage or those who have the metabolic syndrome may be able to prevent or delay the progression to overt diabetes by adopting a healthier lifestyle, of which increasing habitual levels of physical activity isa vital component. Most persons who have diabetes and hypertension or are at risk for these conditions should be able to initiate an exercise program safely after appropriate medical screen-ing and the establishment of an individualized exercise prescription. Despite the increasing amount of evidence that shows the benefits of exercise training, this modality of prevention and treatment continues to be underused. Although patients' lack of knowledge of the benefits of exercise or lack of motivation contributes to this underuse, a lack of clear and specific guidelines from health care professionals also is an important factor. Clinicians need to educate patients about the benefits of exercise for managing their type 2 diabetes and assist in formulating specific advice for increasing physical activity. Specific instructions should be given to patients, rather than general advice, such as "you should exercise more often." Many cardiac re-habilitation and clinical exercise programs can accommodate patients who have type 2 diabetes and hypertension. Such programs can establish individualized exercise prescriptions and provide an environment that is conducive for "lifestyle change" that underlies long-term compliance to exercise and risk factor modification.
Cardiol Clin 2004 Nov
PMID:Role of exercise training on cardiovascular disease in persons who have type 2 diabetes and hypertension. 1550 24

During inflammation, several cell types synthesize and secrete phospholipase A2 that catalyses lipid oxidation in LDL. Myeloperoxidase, a haeme protein secreted by activated phagocytes, oxidizes L-tyrosine to a tyrosyl radical that is a physiological catalyst for the initiation of lipid oxidation in LDL. Lipid oxidation results in the generation of aldehydes that substitute lysine residues in the apolipoprotein B-100 moiety. Lipid together with protein oxidation in LDL results in the generation of oxidized LDL. We, among others, have demonstrated an association between coronary heart disease (CHD) and increased plasma levels of oxidized LDL. Recently, we have demonstrated a higher prevalence of elevated oxidized LDL in persons with high-calculated CHD risk prior to events. The odds of having elevated oxidized LDL for persons with high-calculated CHD risk prior to events were even higher than for persons with diagnosed CHD. A likely explanation is that once CHD has been diagnosed the patients are more treated with a statin that appears to decrease oxidized LDL even beyond its cholesterol-lowering effect. We have identified several metabolic syndrome components (high triglycerides, low HDL-cholesterol, glucose intolerance and diabetes) that independently of LDL-cholesterol, predicted high levels of oxidized LDL. Finally, elevated oxidized LDL predicted myocardial infarction in the Health ABC cohort consisting of well-functioning elderly people, even after adjusting for age, gender, race, smoking, and the metabolic syndrome.
Acta Cardiol 2004 Oct
PMID:Oxidized LDL and coronary heart disease. 1552 50

We determined the prevalence of the metabolic syndrome (MS) with the criteria recommended by the National Cholesterol and Education Program, Adult Treatment Panel III report and estimated the magnitude of cross-sectional associations between the MS, coronary heart disease (CHD), and atherosclerosis in 14,502 black and white middle-age patients in the Atherosclerosis Risk in Communities Study. CHD was ascertained by standardized procedures and subclinical atherosclerosis was determined by measuring carotid intimal medial wall thickness using B-mode ultrasonography. The prevalence of MS was 30%, with substantial variation across race and gender subgroups. Among women but not among men, MS was significantly associated with increasing low-density lipoprotein cholesterol. CHD prevalence was 7.4% among those with the MS compared with 3.6% in comparison subjects (p <0.0001). After adjustment for established risk factors, subjects who had MS were 2 times more likely to have prevalent CHD than were those who did not have the syndrome. Among individuals free of CHD and stroke, after adjustment for age, gender, and race/center, the average intimal-medial wall thickness of carotid arteries was greater among those with versus those without MS (747 vs 704 mum, p <0.0001). Thus, MS was significantly associated with the presence of CHD and carotid intimal medial wall thickness. Identification of patients who have MS may provide opportunities to initiate CHD prevention strategies.
Am J Cardiol 2004 Nov 15
PMID:Prevalence of coronary heart disease and carotid arterial thickening in patients with the metabolic syndrome (The ARIC Study). 1554 Dec 39


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