Metabolic syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]

Overview

Metabolic syndrome is formed by a constellation of medical disorders that increases the risk of developing cardiovascular disease and diabetes mellitus. It affects a large number of people in a clustered fashion. Management of metabolic syndrome involves dietary modifications, exercise and drug therapy for the complications (diabetes, stroke, angina, myocardial infarction) found associated with these conditions.

Medical Therapy

Hypertension

Elevated low-density lipoprotein cholesterol (LDL-C)

  • The goal is to get the LDL down to < 100 mg/dl.
  • Statins are the drugs of choice.
  • However, statins are contraindicated in pregnancy.

Decreased high-density lipoprotein cholesterol (HDL-C)

Elevated Triglycerides

Diabetes

Cardiovascular Risk

Supportive Trial Data

Study on the effects of metformin and life-style changes on the incidence of metabolic syndrome [1]

  • SOURCE and YEAR: Ann Intern Med. 2005
  • OBJECTIVE: The effect of intensive lifestyle intervention and metformin therapy on the syndrome's incidence and resolution
  • METHOD: Randomized controlled trial
  • STUDY POPULATION: 1711 participants
  • STUDY PERIOD: 3.2 years
  • INTERVENTIONS: Metformin, 850 mg twice daily, or intensive lifestyle intervention designed to achieve and maintain a 7% weight loss and 150 minutes of exercise per week.
  • RESULTS:
    • 53% of participants (n = 1711) had metabolic syndrome at baseline
    • Results of Log-rank test
    • Incidence of the metabolic syndrome was reduced by 41% in the lifestyle group (P < 0.001) and by 17% in the metformin group (P = 0.03) compared with placebo.
    • 3 year cumulative incidences were 51%, 45%, and 34% in the placebo, metformin, and lifestyle groups, respectively.
  • CONCLUSION: Lifestyle intervention and metformin therapy reduces the development of metabolic syndrome.

References

  1. 1.0 1.1 1.2 Orchard TJ, Temprosa M, Goldberg R; et al. (2005). "The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial". Annals of Internal Medicine. 142 (8): 611–9. PMC 2505046. PMID 15838067. Unknown parameter |month= ignored (help)
  2. Suzuki T, Homma S (2007). "Treatment of hypertension and other cardiovascular risk factors in patients with metabolic syndrome". Med Clin North Am. 91 (6): 1211–23, x. doi:10.1016/j.mcna.2007.06.009. PMID 17964917.
  3. Ito MK (2004). "The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin". Ann Pharmacother. 38 (2): 277–85. doi:10.1345/aph.1D218. PMID 14742767.
  4. "Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group". Lancet. 352 (9131): 854–65. 1998. PMID 9742977. Unknown parameter |month= ignored (help)
  5. Nathan DM, Buse JB, Davidson MB; et al. (2006). "Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes". Diabetes Care. 29 (8): 1963–72. doi:10.2337/dc06-9912. PMID 16873813. Unknown parameter |month= ignored (help)
  6. Smith JP, Haddad EV, Taylor MB; et al. (2012). "Suboptimal inhibition of platelet cyclooxygenase-1 by aspirin in metabolic syndrome". Hypertension. 59 (3): 719–25. doi:10.1161/HYPERTENSIONAHA.111.181404. PMC 3418792. PMID 22311905. Unknown parameter |month= ignored (help)

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