Metabolic Syndrome. From Risk Factor to Management E-Book

Michael J. Blaha

• Herausgeber: SEEd Edizioni Scientifiche
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2012

Beschreibung

Increased caloric intake, increased refined carbohydrate consumption, and physical inactivity have led to an explosion in the worldwide incidence of abdominal obesity and the emerging epidemic of insulin resistance, resulting in an increase of metabolic syndrome. Physicians can use the metabolic syndrome concept to guide focused lifestyle changes, lower blood pressure goals, and earlier intervention with aspirin, LDL-lowering drugs, and perhaps insulin-sensitizing medications. The comprehensive “ABCDE” approach presented in this book provides a memory tool for use in everyday clinical practice. In this unique, easy-to-read text, the 17 most important clinical trials in the field of the metabolic syndrome are presented, that every clinician should know.

Leseprobe

Metabolic Syndrome

From Risk Factors to Management

Michael J. Blaha, Rajesh Tota-Maharaj

Colophon

© SEEd srl

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First edition

May 2012 ISBN 978-88-9741-920-4

Although the information about medication given in this book has been carefully checked, the author and publisher accept no liability for the accuracy of this information. In every individual case the user must check such information by consulting the relevant literature.

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Introduction

Increased caloric intake, increased refined carbohydrate consumption, and physical inactivity have led to an explosion in the worldwide incidence of abdominal obesity and the emerging epidemic of insulin resistance.

The metabolic syndrome is a multiplex risk factor for cardiovascular disease and type 2 diabetes that reflects the clustering of individual risk factors that result from abdominal obesity and insulin resistance. This multiplex is currently thought to comprise the following interrelated metabolicrisk conditions: atherogenic dyslipidemia, glucose intolerance, elevated blood pressure, proinflammatory state, and prothrombotic state. These place affected patients at risk for the following clinical diseases: coronary artery disease, cerebrovascular disease, atrial fibrillation, type 2 diabetes, fatty liver disease, obstructive sleep apnea, sexual dysfunction, cognitive decline, and cancer.

While there has been a great deal of historical controversy regarding the utility of the metabolic syndrome as a clinical diagnosis, it is now widely accepted that the syndrome effectively alerts physicians to an important patient phenotype and aids communication and patient teaching. While not itself a risk scoring instrument, the metabolic syndrome can be used as a tool for modulating the risk obtained using traditional risk equations such as the Framingham Risk Score, particularly among otherwise low-risk patients. Physicians can use the metabolic syndrome concept to guide focused and more aggressive lifestyle changes, lower blood pressure goals, and earlier intervention with aspirin, LDL-lowering drugs, and perhaps insulin-sensitizing medications.

The comprehensive “ABCDE” approach presented in this book provides a memory tool for use in everyday clinical practice. In this unique, easy-to-read text, we also present the 17 most important clinical trials in the field of the metabolic syndrome that every clinician should know.

1 The Metabolic Syndrome. A Global Problem

Michael J. Blaha

Clinical Case

A 52-year-old South Asian-born man presents for a routine medical evaluation complaining of intermittent erectile dysfunction. He has a family history of hypertension, type 2 diabetes, and coronary artery disease. He is sedentary and overweight, with the majority of his adipose tissue present around his waist, which measures 43 inches (109cm) in circumference. His blood pressure is mildly elevated at 135/85mmHg. Routine laboratory evaluation reveals a fasting glucose of 110mg/dl, aspartate aminotransferase of 60U/l, alanine aminotransferase of 74U/l, total cholesterol of 187mg/dl, LDL cholesterol of 104mg/dl, HDL cholesterol of 32mg/dl, and triglycerides of 213mg/dl. High sensitivity C-reactive protein is 3.7mg/dl. Urinalysis is notable for 1+ protein. Liver ultrasound reveals infiltration with adipose tissue. The patient currently takes no medications and does not smoke. Framingham Risk Score is 7%. The patient was given a diagnosis of metabolic syndrome. He subsequently underwent coronary artery calcium quantification by cardiac computed tomography which showed a high score of 320. He was placed on an aggressive lifestyle modification program, which encouraged a reduction in consumption of refined carbohydrates such as sugared cola, an increase in consumption of fruits, vegetables, healthy oils, and nuts, as well as an increase in exercise. In addition, the patient was started on 81mg of aspirin, 10mg of atorvastatin, and 2.5mg of lisinopril. Each of these therapeutic choices was informed by a diagnosis of metabolic syndrome, with aspirin and statin therapies that are more aggressive than currently recommended by most international guidelines.