Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Metabolic syndrome medical therapy
Introduction
Overview
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
Medical Therapy
- The first line of treatment is a change of lifestyle (i.e, caloric restriction, physical activity, weight loss). However, drug treatment is frequently required to prevent complications of metabolic syndrome.[1]
Hypertension
- BP goal- 140/90 or 130/80 in diabetics (JNC 7 guidelines).
- Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) should be preferred over diuretics or beta-blockers in these patients.[2]
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)
- Diet (decreased calorie intakes)
- Increased physical activity
- Niacin
- Cholesteryl ester transfer protein (CETP) inhibitors (torcetrapib) and (anacetrapib) are currently investigational agents and the clinical benefits associated with the documented raising of HDL levels are unproven.
Elevated Triglycerides
- Fibric acid
- Niacin (however at higher doses (>1500 mg/d) it may exacerbate hyperglycemia) [3]
- Addition of omega-3 fatty acids also produces beneficial effects.
Diabetes
- Use of drugs that decrease insulin resistance e.g., metformin.[1] [4] Use of thiazolidinediones is controversial and not FDA approved.[5]
Cardiovascular Risk
- Aspirin therapy may be helpful in the primary prevention of cardiovascular complications.[6]
Supportive Trial Data
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
References
- ↑ 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) - ↑ 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.
- ↑ 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.
- ↑ “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) - ↑ 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) - ↑ 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)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]