Latest news on metabolic syndrome
The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin, that appear to directly promote the development of atherosclerotic CVD as well as increase the risk for developing type 2 diabetes. In patients with the metabolic syndrome, relative risk for CVD ranges from 1.5-3.0 depending on the stage of progression . The diabetes is not yet present, risk for progression to type 2 diabetes averages about five- fold increase compared with those without the syndrome. The ATP III criteria required no single factor for diagnosis, but instead made the presence of three of five factors the basis for establishing the diagnosis. The AHA and NHLBI recently reaffirmed the utility of ATP III criteria, with minor modification. According to the new IDF definition for a person to be defined as having the metabolic syndrome they must have central obesity plus any two of four other factors of updated ATP III.
The pathogenesis of the metabolic syndrome is multifactor. The major underlying
menace factors are obesity and insulin resistance. Risk associated with obesity is best identified by increased waist circumference abdominal obesity. Insulin resistance can be secondary to obesity but can have genetic components as well. Several factors further exacerbate the syndrome, physical inactivity, advancing age, endocrine dysfunction, and genetic aberrations affecting individual risk factors. The increasing prevalence of metabolic syndrome in the United States of America and worldwide, however, seems to be driven largely by more obesity exacerbated by sedentary lifestyles.
The primary goal of clinical management in individuals with the metabolic syndrome
is to reduce risk for clinical atherosclerotic disease. Even in people with the metabolic
syndrome, first-line therapy is directed toward the major risk factors, LDL, cholesterol
above goal, hypertension and diabetes. Prevention of type 2 diabetes is another important goal when it is not present in a person with the metabolic syndrome. For individuals with established diabetes, risk factor management must be intensified to diminish their higher risk for atherosclerotic CVD.
The metabolic syndrome itself is not a robust risk assessment tool for estimating absolute 10 year risk, but its presence calls for more extensive short term risk assessment, either by risk factor scoring or imaging for sub clinical atherosclerosis. The primary intervention is lifestyle therapy, particularly weight reduction and increased exercise.
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