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

The latest report from the National Cholesterol Education Program has reaffirmed that the primary lipid goal for the prevention of atherosclerotic vascular disease (AVD) is to achieve a normal low-density lipoprotein (LDL) cholesterol (<130 mg/dL) by diet in normal individuals, and by diet and statin therapy in patients with multiple risk factors. Patients with any clinical AVD (which includes diabetes) will need a statin to achieve an optimal LDL cholesterol (<100 mg/dL). The recent Heart Protection Study might revise our thinking further. Patients at high risk achieved a reduction in mortality and vascular events taking simvastatin 40 mg, even if they had a low baseline LDL value. Individuals with the metabolic syndrome and insulin resistance do not typically have a very high LDL, but rather have elevated triglycerides and a low high-density lipoprotein (HDL) cholesterol. They, too, need to be treated with a statin, first to achieve an appropriate LDL goal. This is insufficient if the triglyceride value exceeds 200 mg/dL. They should be treated to achieve a non-HDL cholesterol goal (equal to total cholesterol minus HDL cholesterol) that is 30 mg/dL higher than the LDL goal.
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PMID:Evaluation and treatment of lipid disorders in women. 1262 78

The constellation of risk factors known as the metabolic syndrome increases the risk of coronary artery disease at any low-density lipoprotein (LDL) cholesterol level. We performed an exploratory analysis of data from 5 trials to study the effects of rosuvastatin 10 mg on lipid levels and ratios in hypercholesterolemic patients (LDL cholesterol > or =160 mg/dL and <250 mg/dL) who met a modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition of the metabolic syndrome. Of 580 patients completing 12 weeks of treatment with rosuvastatin 10 mg, 194 (33%) met the definition of the metabolic syndrome by exhibiting > or =3 of the following: body mass index >30; triglycerides > or =150 mg/dL; high-density lipoprotein (HDL) cholesterol <40 mg/dL in men and <50 mg/dL in women; blood pressure > or =130/> or =85 mm Hg or receiving current medication for hypertension; and fasting blood glucose > or =110 mg/dL. Patients with the metabolic syndrome had higher triglyceride, non-HDL cholesterol, apolipoprotein B, and lipid ratios, and lower HDL cholesterol and apolipoprotein A-I levels, at baseline compared with patients without the metabolic syndrome. In patients with the metabolic syndrome, rosuvastatin 10 mg improved LDL cholesterol (-47%), non-HDL cholesterol (-43%), non-HDL cholesterol/HDL cholesterol ratio (-47%), apolipoprotein B (-37%), apolipoprotein B/apolipoprotein A-I ratio (-40%), triglycerides (-23%), apolipoprotein A-I (+7%), and HDL cholesterol (+10%)-in a manner similar to that in hypercholesterolemic patients who did not meet these criteria. Among patients who met the metabolic syndrome criteria and who had triglycerides > or =200 mg/dL, 64% met their ATP III non-HDL goals.
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PMID:Efficacy of rosuvastatin 10 mg in patients with the metabolic syndrome. 1264 42

The metabolic syndrome is a complex constellation of disorders, each one a significant risk factor for the development of cardiovascular disease (CVD). The increasing prevalence of this condition is a major concern for healthcare providers both in Europe and North America. The concern surrounding the prevalence of the metabolic syndrome is reflected in the recently published National Cholesterol Education Program Adult Treatment Panel III guidelines. Although complex in nature, the individual components of the metabolic syndrome appear to be linked by the presence of insulin resistance. Concurrently treating the underlying insulin resistance along with the complex array of other disorders should form the core of any management strategy. Treatment of atherogenic dyslipidaemia should be a major aim, since it is associated with a significant risk of CVD. While lifestyle modifications form the cornerstone of any dyslipidaemia management strategy, many patients require the addition of lipid-modifying drugs. Several agents are available for the treatment of lipid abnormalities, including fibrates, bile acid sequestrants, niacin and hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins). Of these, statins should be used as the first treatment option in the majority of patients because they are efficacious for reducing low-density lipoprotein cholesterol, are effective across the lipid profile and are well tolerated in the majority of cases. Furthermore, the American Diabetes Association (ADA) recommends statins as first-line pharmacological treatment of dyslipidaemia in patients with diabetes mellitus. This review discusses the diagnosis and management of the metabolic syndrome and examines the potential of future treatment options.
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PMID:The metabolic syndrome: targeting dyslipidaemia to reduce coronary risk. 1266 9

The metabolic syndrome, or insulin resistance syndrome, is associated with increased risk for cardiovascular disease and related mortality and has an estimated age-adjusted US prevalence of 23.7%. Dyslipidemia in the syndrome is characterized by hypertriglyceridemia, low high-density lipoprotein cholesterol, and small, dense low-density lipoprotein (LDL) particles in the context of normal/slightly elevated LDL cholesterol. Outcomes in treatment studies in or including diabetic patients suggest that a variety of therapies may be of benefit in reducing cardiovascular risk in patients with the metabolic syndrome, including physiologic therapies and pharmacologic treatments, such as aspirin, antihypertensive therapy, anti-ischemic therapy, and lipid-modifying therapies. The recently updated National Cholesterol Education Program Adult Treatment Panel III guidelines identify the metabolic syndrome as a secondary target of lipid-lowering therapy after LDL cholesterol reduction and recommend use of weight reduction and increased physical activity to address underlying risk factors as well as therapies to address specific lipid and nonlipid risk factors.
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PMID:Treatment for patients with the metabolic syndrome. 1267 1

The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for lipid-lowering therapy to reduce coronary heart disease (CHD) risk contain a number of features that distinguish them from the previous ATP guidelines. These new features include modifications in lipid/lipoprotein levels considered optimal, abnormal, or reflective of risk; increased focus on primary prevention through use of Framingham risk scoring to define risk in persons with multiple lipid/nonlipid risk factors; and increased focus on the association of the metabolic syndrome with CHD risk. The introduction of the category of CHD risk equivalents-including persons with atherosclerotic disease, diabetes, or 10-year CHD risk > 20% based on Framingham scoring-results in an increase over previous guidelines in the proportion of patients categorized as being at high risk and therefore eligible for more intensive low-density lipoprotein cholesterol (LDL-C)-lowering therapy. Use of the new secondary therapeutic target of non-high-density lipoprotein cholesterol should improve management of lipid risk factors in patients who have elevated triglyceride levels after LDL-C goals have been met. These new features of the NCEP ATP III guidelines should improve identification and treatment of patients with dyslipidemias associated with CHD risk.
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PMID:New features of the National Cholesterol Education Program Adult Treatment Panel III lipid-lowering guidelines. 1270 35

Although the individual components of the metabolic syndrome are clearly associated with increased risk for coronary heart disease (CHD), we wanted to quantify the increased prevalence of CHD among people with metabolic syndrome. The Third National Health and Nutrition Examination Survey (NHANES III) was used to categorize adults over 50 years of age by presence of metabolic syndrome (National Cholesterol Education Program [NCEP] definition) with or without diabetes. Demographic and risk factor information was determined for each group, as well as the proportion of each group meeting specific criteria for metabolic syndrome. The prevalence of CHD for each group was then determined. Metabolic syndrome is very common, with approximately 44% of the U.S. population over 50 years of age meeting the NCEP criteria. In contrast, diabetes without metabolic syndrome is uncommon (13% of those with diabetes). Older Americans over 50 years of age without metabolic syndrome regardless of diabetes status had the lowest CHD prevalence (8.7% without diabetes, 7.5% with diabetes). Compared with those with metabolic syndrome, people with diabetes without metabolic syndrome did not have an increase in CHD prevalence. Those with metabolic syndrome without diabetes had higher CHD prevalence (13.9%), and those with both metabolic syndrome and diabetes had the highest prevalence of CHD (19.2%) compared with those with neither. Metabolic syndrome was a significant univariate predictor of prevalent CHD (OR 2.07, 95% CI 1.66-2.59). However, blood pressure, HDL cholesterol, and diabetes, but not presence of metabolic syndrome, were significant multivariate predictors of prevalent CHD. The prevalence of CHD markedly increased with the presence of metabolic syndrome. Among people with diabetes, the prevalence of metabolic syndrome was very high, and those with diabetes and metabolic syndrome had the highest prevalence of CHD. Among all individuals with diabetes, prevalence of CHD was increased compared with those with metabolic syndrome without diabetes. However, individuals with diabetes without metabolic syndrome had no greater prevalence of CHD compared with those with neither.
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PMID:NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. 1271 54

Updated guidelines from the National Cholesterol Education Program give greater emphasis to lipoproteins other than low-density lipoprotein cholesterol (LDL) than previous guidelines. Although statins remain first-line therapy for most patients to lower LDL, combination therapy is the next logical step in achieving goals in patients with mixed dyslipidemia or elevated LDL despite statin therapy. As the prevalence of diabetes, metabolic syndrome, and atherogenic dyslipidemia rises, the importance of treating the total lipid profile becomes even more crucial. Niacin, fibrates, and bile acid sequestrants are effective in combination with statins in lowering LDL, triglycerides, and total cholesterol levels and increasing high-density lipoprotein cholesterol (HDL). Although combination therapies may increase the risk of myopathy, both fibrate-statin and niacin-statin combinations are considered safe. In addition, niacin-statin therapy reduces atherosclerotic progression and coronary events. New pharmacologic formulations exist that will further affect treatment: a single-tablet combination of lovastatin and extended-release niacin is available, as is ezetimibe, a cholesterol-absorption inhibitor. In all, both HDL and triglyceride levels correlate with cardiovascular risk and should be considered secondary targets of therapy. Combination therapy can be safe and effective and can be constructed to affect all lipoprotein parameters.
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PMID:Treating dyslipidemic patients with lipid-modifying and combination therapies. 1274 37

To examine the association between the metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count, the author did a cross-sectional analysis of data from 8570 participants aged >/=20 years from the Third National Health and Nutrition Examination Survey (1988-1994). The metabolic syndrome was defined using criteria established by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The age-adjusted prevalence of having an elevated C-reactive protein concentration was 29.0% (S.E.: 1.6%) for participants with the metabolic syndrome and 12.1% (S.E.: 0.6%) for participants without the metabolic syndrome (adjusted odds ratio (OR), 2.80; 95% confidence interval (CI): 2.36, 3.33). Compared with participants who had no abnormalities, the corresponding adjusted ORs were 1.91 (95% CI: 1.27, 2.87), 3.00 (95% CI: 1.96, 4.60), 5.01 (95% CI: 3.39, 7.41), 5.97 (95% CI: 3.83, 9.31), and 6.79 (95% CI: 3.55, 12.99) for participants with 1, 2, 3, 4, and 5 metabolic abnormalities, respectively. Participants with the metabolic syndrome had higher fibrinogen concentrations and white blood cell counts than those without this syndrome. Many people with the metabolic syndrome have a low-grade inflammation, which may increase their risk for future adverse events. A better understanding of the potential consequences of the high prevalence of low-grade inflammation among people with the metabolic syndrome is needed.
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PMID:The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: findings from the Third National Health and Nutrition Examination Survey. 1280 19

We estimated the coronary heart disease (CHD) events that are preventable by treatment of lipids and blood pressure in patients with metabolic syndrome (MetS), a contributor to coronary heart disease (CHD). Among patients aged 30 to 74 years (without diabetes or CHD) in the United States, MetS was defined by National Cholesterol Education Program criteria. CHD events over a period of 10 years were estimated by Framingham algorithms. Events that could be prevented by statistically "controlling" blood pressure, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol to either normal or optimal levels according to national guidelines were calculated. Of 7.5 million men and 9.0 million women aged 30 to 74 years with MetS, approximately 1.5 million men and 0.45 million women, if untreated, developed CHD events in 10 years. In men and women, blood pressure control to normal levels "prevented" 28.1% and 12.5% of CHD events, respectively (p <0.01); control to optimal levels resulted in preventing 28.2% and 45.2% of events, respectively (p <0.01). Control of HDL cholesterol to normal levels resulted in preventing 25.3% of events in men and 27.3% in women; optimal control prevented 51.2% and 50.6% of events, respectively. Control of LDL cholesterol to normal levels prevented 9.3% of events in men and 9.8% of events in women; control to optimal levels prevented 46.2% and 38.1% of events (p <0.05), respectively. Control of all 3 risk factors to normal levels resulted in preventing 51.3% of events for men and 42.6% for women; control to optimal levels resulted in preventing 80.5% and 82.1% of events, respectively. Thus, many CHD events in patients with MetS may be preventable by nominal or optimal control of lipids and/or blood pressure.
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PMID:Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome. 1280 27

The recent focus on emerging cardiovascular risk factors, such as C-reactive protein, homocysteine, and small, dense low-density lipoprotein (LDL), may give the false impression that the current approach to the assessment of cardiovascular disease risk fails to identify a large section of the high-risk population. On the contrary, the new guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) propose classifying an enormous number of individuals, including people with any form of atherosclerotic disease, diabetes, and a combination of major risk factors, into the category of high risk (>20% likelihood of a major coronary event or stroke in 10 years). Considering the widespread prevalence of the metabolic syndrome-a high-risk condition characterized by mild hypertension, mild dyslipidemia, hyperglycemia, and visceral obesity-we may be faced with the challenge of implementing aggressive risk reduction therapies in as much as 30% of the adult US population. From the point of view of risk assessment, a practical approach is to follow the NCEP guidelines (ie, place patients with diabetes and those with atherosclerotic complications in the highest risk category), apply the Framingham calculation to determine risk in people with common risk factors, and initiate early intervention in people who have familial hypercholesterolemia (LDL cholesterol >200 mg/dL) or a family history of early cardiovascular disease. The emerging risk factors may be useful for further stratifying risk in individuals with intermediate risk and the presence of risk factors not included in the Framingham calculation.
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PMID:A practical approach to risk assessment to prevent coronary artery disease and its complications. 1286 51


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