Abstract
Metabolic syndrome affects approximately one quarter of population in developed countries.
Its presence is a major risk for development of both type 2 diabetes (T2DM) and atherosclerosis.
The prevalence of cardiovascular disease is 2–3 times higher in individuals with metabolic
syndrome than in age-matched controls. Most important components of metabolic syndrome
are insulin resistance with or without glucose intolerance, abdominal obesity, atherogenic
dyslipidaemia, hypertension, prothrombotic state and proinflammatory state. Early
identification of subjects with metabolic syndrome is very important, since they represent
a target group for multiple lifestyle and pharmacological interventions. Lifestyle
interventions, antiobesity drugs and drugs increasing insulin sensitivity prevented
development of T2DM in subjects with impaired glucose tolerance in randomized trials.
Treatment of atherogenic dyslipidaemia to the therapeutic goals defined for diabetic
patients seems reasonable and both statins and fibrates could be used based on evidence
from clinical trials. Treatment of hypertension should also aim for target levels
similar to those in diabetic patients. Using drugs affecting renin-angiotensin II
axis, as first choice seems reasonable based on evidence from clinical trials showing
the ability of these drugs to prevent T2DM and decrease albuminuria.
Keywords
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References
- NCEP-defined metabolic syndrome, diabetes and prevalence of coronary heart disease among NHANES III participants age 50 years and older.Diabetes. 2003; 52: 1210-1213
- Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study.Circulation. 2003; 108: 414-419
- Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.Br. Med. J. 2000; 321: 405-412
- Role of insulin resistance in human disease.Diabetes. 1988; 37: 1595-1607
- Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease.Circulation. 2002; 106: 286-288
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III), Final report, Circulation 106 (2002) 3143–3421.
- Endocr. Pract. 2003; 9: 17-19
- Fasting and postchallenge glycemia and cardiovascular disease risk.Diabetes Care. 2002; 25: 1845-1850
- Glucose tolerance and cardiovascular mortality: comparison of fasting and 2 h diagnostic criteria.Arch. Intern. Med. 2001; 161: 397-405
- Hypertriglyceridemic waist, a marker of the atherogenic metabolic triad (hyperinsulinemia, hyperapolipoprotein B, small dense LDL) in men?.Circulation. 2000; 102: 179-184
- Use of metabolic markers to identify overweight individuals who are insulin resistant.Ann. Intern. Med. 2003; 139: 802-809
- Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European Prospective Investigation into Cancer in Norfolk.Ann. Intern. Med. 2004; 141: 413-420
- Diabetes Prevention Program Research Group, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N. Engl. J. Med. 2002; 346: 393-403
- UK Prospective Diabetes Study (UKPDS) Group.Lancet. 1998; 352: 854-865
- Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes.Diabetes Care. 2002; 25: 2244-2248
- For the Investigators in the Prevention of Restenosis with Tranilast and its Outcomes Trial, Relation of metformin treatment to clinical events in diabetic patients undergoing percutaneous intervention.Am. J. Cardiol. 2004; 93: 1347-1350
- Preventative effects of rosiglitazone on restenosis after coronary stent implantation in patients with type 2 diabetes.Diabetes Care. 2004; 27: 2654-2660
- Preservation of pancreatic β-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women.Diabetes. 2002; 51: 2796-2803
S.M. Grundy, H.B. Brewer, J.I. Cleeman, S.C. Smith, C. Lenfant, for the Conference Participants, Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition, Circulation 109 (2004) 433–438.
- Finnish Diabetes Prevention Study Group Prevention of type 2 diabetes mellitus by change in lifestyle among subjects with impaired glucose tolerance.N. Engl. J. Med. 2001; 344: 1343-1350
- XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) Study. A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.Diabetes Care. 2004; 27: 155-161
- Hypertriglyceridemic hyperapoB in type 2 diabetes.Diabetes Care. 2002; 25: 579-582
- Abdominal obesity and dyslipidemia in the metabolic syndrome: importance pf type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk.J. Clin. Endocrinol. Metab. 2004; 89: 2601-2607
- Comparison of the associations of apolipoprotein B and low-density lipoprotein cholesterol with other cardiovascular risk factors in the Insulin Resistance Atherosclerosis Study (IRAS).Circulation. 2003; 108: 2312-2316
- Apolipoprotein B determines risk for recurrent coronary events in postinfarction patients with metabolic syndrome.Atherosclerosis. 2004; 177: 367-373
- Different levels of cardiovascular risk factors in Type 2 diabetic patients with lower limb proximal and distal vessel macroangiopathy.Cor. Vasa. 1990; 32: 311-319
- The severity of coronary atherosclerosis in type 2 diabetes mellitus is related to the number of circulating triglyceride-rich lipoprotein particles.Arterioscler. Thromb. Vasc. Biol. 1997; 17: 3633-3638
- Carotid intima-media thickness in type 2 diabetes is more strongly related to serum apoprotein A-I in females.Wien Klin Wochenschr. 2001; 113: 194-198
- Diabetes mellitus or lipidus?.Diabetologia. 2003; 46: 433-440
- Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes.N. Engl. J. Med. 2004; 350: 664-671
- Improved nonalcoholic steatohepatitis after 48 weeks of treatment with the PPAR-gamma ligand rosiglitazone.Hepatology. 2003; 38: 1008-1017
- Comparative effects of cerivastatin and fenofibrate on the atherogenic lipoprotein phenotype in proteinuric renal disease.J. Am. Soc. Nephrol. 2001; 12: 341-348
- Reduced coronary events in simvastatin-treated patients with coronary heart disease and diabetes or impaired fasting glucose levels.Arch. Intern. Med. 1999; 159: 2661-2667
- Reduction of cardiovascular events by simvastatin in nondiabetic coronary heart disease patients with and without the metabolic syndrome.Diabetes Care. 2004; 27: 1735-1740
- Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose. Results from the LIPID trial.Diabetes Care. 2003; 26: 2713-2721
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.Lancet. 2003; 361: 2005-2016
- Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre placebo-controlled trial.Lancet. 2004; 364: 685-696
- Some coronary risk factors related to the insulin resistance syndrome and treatment with gemfibrozil. Experience from the Helsinki Heart Study.Circulation. 1995; 92: 1779-1785
- Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT).Arch. Intern. Med. 2002; 162: 2597-2604
- Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: The Bezafibrate Infarction Prevention (BIP) Study.Circulation. 2000; 102: 21-27
- Peroxisome proliferator-activated receptor ligand bezafibrate for prevention of type 2 diabetes mellitus in patients with coronary artery disease.Circulation. 2004; 109: 2197-2202
- Hypertension and associated metabolic abnormalities – the role of insulin resistance and the symptoadrenal system.N. Engl. J. Med. 1996; 334: s374-s381
- Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.Br. Med. J. 1998; 317: 703-713
- for the HOT Study Group Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial.Lancet. 1998; 351: 1755-1762
- HOPE study investigators, Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals.J. Am. Med. Assoc. 2001; 286: 421-426
- Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy.Lancet. 2000; 355: 253-259
- LIFE Study Group Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.Lancet. 2002; 359: 1004-1010
- HOPE Study Investigators, Ramipril and the development of diabetes.J. Am. Med. Assoc. 2001; 286: 1881-1885
- for the LIFE Study Group Risk of new-onset diabetes in the Losartan Intervention for Endpoint Reduction in Hypertension Study.J. Hypertension. 2002; 20: 1879-1886
- ENAAL Study Investigators, Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N. Engl. J. Med. 2001; 345: 861-869
- on the behalf of the BIGPRO Study Group Effect of weight change and metformin on fibrinolysis and the von Willebrand Factor in obese nondiabetic subjects.Diabetes Care. 1998; 21: 1967-1972
- Nonhypoglycemic Effects of Thiazolidinediones.Ann. Intern. Med. 2001; 134: 61-71
- C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14719 initially healthy American women.Circulation. 2003; 107: 391-397
- Comparison of the effects of atorvastatin or fenofibrate on nonlipid biochemical risk factors and the LDL particle size in subjects with combined hyperlipidemia.Am. Heart J. 2002; 144: 6
- Effect of rosiglitazone treatment on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus.Circulation. 2002; 106: 679-684
- Familial combined hyperlipidemia is associated with upstream transcription factor 1 (USF1).Nature Genet. 2004; 36: 371-376
- USF1 implicated in the aetiology of familial combined hyperlipidaemia and the metabolic syndrome.Trends Mol. Med. 2004; 10: 362-365
- European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice.Eur. Heart J. 2003; 24: 1601-1610
Article info
Publication history
Published online: March 18, 2005
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© 2005 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
