Relationship between antihypertensive drugs and metabolic syndrome

Metabolic syndrome is a cluster of risk factors associated with an increased risk for cardiovascular disease and type 2 diabetes. Based on data from 1988 to 1994, it is estimated that 24% of adults in the United States meet the criteria for diagnosis of metabolic syndrome. The use of certain medications increases the risk for metabolic syndrome by either promoting weight gain or the development of changes in lipid or glucose metabolism. Diuretics and beta-blockers are among the agents recommended for first-line therapy for hypertension, yet these medications increase the risk of metabolic syndrome. Healthcare providers should recognize and understand the risk associated with antihypertensive agents and should appropriately monitor for changes related to metabolic syndrome. Careful attention to drug choices should be given with patients who are overweight or have other risk factors for diabetes or cardiovascular disease.     

Ethnic, gender, and age-related differences in patients with the metabolic syndrome

The metabolic syndrome is a clustering of cardiovascular risk factors and is associated with an increased risk of developing diabetes, cardiovascular disease, and kidney disease. Epidemiologic studies have demonstrated differences in prevalence by age, gender, and ethnicity. The prevalence of the metabolic syndrome increases with age through the sixth decade of life among men and seventh decade among women. Most, but not all, studies reported a higher prevalence of the metabolic syndrome among women compared with men. Although the metabolic syndrome is more common among Mexican Americans compared with non-Hispanic whites and blacks, among men the metabolic syndrome is more common among non-Hispanic whites than non-Hispanic blacks; the reverse is true among women. Understanding the basic pathophysiology underlying the metabolic syndrome may help explain the age, gender, and ethnic differences in its prevalence and guide preventive and therapeutic efforts.     

Metabolic syndrome in patients with coronary heart disease. Results of using different diagnostic criteria

A unified definition of metabolic syndrome, considered a common feature of cardiovascular risk, is lacking. The aim of this study was to compare the prevalence of this syndrome in patients with ischemic heart disease using two diagnostic criteria: the European Group of Resistance to Insulin and the National Cholesterol Education Program. We designed an observational, cross-sectional study of the factors that make up metabolic syndrome in subjects diagnosed with coronary heart disease. A total of 169 patients aged 35 to 79 years were studied (129 men and 40 women). With the European group criterion the percentage of patients with metabolic syndrome was 43.7%, whereas the American group criterion yielded a prevalence of 40.8% (no significant difference). The prevalence of metabolic syndrome among patients with ischemic heart disease is high. The diagnostic criteria used are similar and do not differ significantly, although diagnostic concordance was only 50%.     

The metabolic syndrome in treatment-seeking obese persons

Obesity is a major risk factor for several metabolic diseases, frequently clustering to form the metabolic syndrome, carrying a high risk of cardiovascular mortality. We aimed to assess the prevalence of the metabolic syndrome in treatment-seeking obese subjects and the potential protective effect of physical activity. A cross-sectional analysis of data from a large Italian database of treatment-seeking obese subjects was performed. The metabolic syndrome was defined according to the criteria provisionally set by the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, based on waist circumference, fasting glucose, triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) levels, and arterial pressure. Data were available in 1,889 Caucasian subjects, 78% females, from 25 obesity centers. Minimum criteria for the metabolic syndrome were fulfilled in 53% of cases. The prevalence increased with age and obesity class and was negatively associated with participation in a structured program of physical activity (odds ratio, 0.76; 0.58 to 0.99; P =.041), after correction for age, sex, and body mass. The prevalence of cardiovascular disease was higher in subjects with the metabolic syndrome. A subset of 12.8% of cases had no metabolic abnormalities. They had a lower prevalence of abdominal obesity and cardiovascular disease. Isolated obesity was significantly associated with physical activity (odds ratio, 1.86; 1.33 to 2.60; P =.0003). Multiple metabolic disorders are present in most obese patients, and their prevalence is lower in physically active subjects. It is time to move towards a more integrated approach and to reconsider resource allocation to improve lifestyle changes for large-scale control of obesity.     

Drug-induced metabolic syndrome

The metabolic syndrome is a cluster of risk factors associated with an increased risk for cardiovascular disease and type 2 diabetes. Based on data from 1988 to 1994, it is estimated that 24% of adults in the United States meet the criteria for diagnosis of the metabolic syndrome. The use of certain medications may increase the risk of the metabolic syndrome by either promoting weight gain or altering lipid or glucose metabolism. Health providers should recognize and understand the risk associated with certain medications and appropriately monitor for changes related to the metabolic syndrome. Careful attention to drug choices should be paid in patients who are overweight or have other risk factors for diabetes or cardiovascular disease.     

Metabolic syndrome and prevalence in an urban,medically underserved,community-based population

ProblemThe metabolic syndrome is a constellation of risk factors thought to indicate increased risk for type 2 diabetes (T2DM) and cardiovascular disease (CVD). Clinical utility of the metabolic syndrome lies in identifying patients at risk of T2DM and CVD and motivating them to reduce underlying risks. However, there appears to be a paradoxical difference in the incidence and prevalence of the metabolic syndrome when comparing African Americans to other population groups. This study is meant to examine capability of detecting metabolic syndrome among minority individuals in a community-based sample.MethodsRelevant measures were collected from 107 community-members at a community-based event. Means for measures were calculated, as were estimates of the sample likely to have metabolic syndrome based on ATP-III criteria.ResultsParticipants had a mean age of 49.5 years. Various proportions of the sample reflected components of the metabolic syndrome using ATP-III criteria, including high blood pressure (59.6%), elevated waist circumference (49.3%), elevated triglyceride levels (33.7%), elevated fasting blood glucose levels (28.6%) and reduced HDL-C (26.7%). Prevalence of metabolic syndrome was considered for 71 (66.35%) of the sample with adequate data; 28.17% presented with three or more of the ATP-III components.ConclusionsThere is a need for a primary prevention intervention among minority community-members. An intensive lifestyle intervention to address all of the metabolic risk factors simultaneously, including an atherogenic diet, weight loss, increased physical activity and smoking cessation is preferable rather than only pharmacologic treatment.     

Obesity and the metabolic syndrome in the elderly--a mini-review

The metabolic syndrome is defined as a cluster of cardiometabolic risk factors which are related to insulin resistance. Beyond the importance of each separate risk factor, the aggregation of abdominal obesity, impaired glucose metabolism, dyslipidemia and hypertension, summarized as the metabolic syndrome, characterizes individuals with a significant increase in the risk for type 2 diabetes and cardiovascular disease. In the prosperous countries of the world, the prevalence of the metabolic syndrome is about 20% in the adult population, and increases with increasing age, which is mainly attributed to the significant increase in overweight and obesity, also in elderly. Current data indicate that weight-loss therapy improves physical function, quality of life and the medical complications associated with obesity. This review summarizes epidemiologic data, diagnostic criteria and the clinical importance of the metabolic syndrome, the complex pathophysiologic mechanisms involved in the development of insulin resistance in elderly, and the various therapeutic options. According to these data the identification and treatment of patients with a metabolic syndrome would be an important approach to reduce morbidity and impairments in the elderly.     

Therapeutic approaches in the prevention of cardiovascular disease in metabolic syndrome and in patients with type 2 diabetes

PURPOSE OF REVIEW: The metabolic syndrome is commonly encountered in the United States. It has been estimated from a survey conducted nearly a decade ago that one in four American adults fulfill the criteria for the metabolic syndrome. As obesity has become more common, the prevalence of type 2 diabetes has increased, and these trends can be expected to translate into more cardiovascular disease in future years. The high cardiovascular risk that accompanies the metabolic syndrome and type 2 diabetes mandates comprehensive and aggressive preventive care. This article reviews evidence that treatments directed at the individual components of the metabolic syndrome will delay the progression to type 2 diabetes and will reduce the incidence of cardiovascular disease. RECENT FINDINGS: In overweight individuals with the metabolic syndrome, the onset of type 2 diabetes can be delayed by therapeutic lifestyle changes (weight loss and exercise), insulin sensitizers (metformin, troglitazone), angiotensin converting enzyme inhibitors (captopril, fosinopril, ramipril), and angiotensin receptor blockers (losartan, candesartan). Lipid altering therapies (statins, fibrates, and niacin) are especially efficacious for reducing cardiovascular events in metabolic syndrome and type 2 diabetes patients. SUMMARY: An aggressive multifactorial approach to cardiovascular risk factor modification facilitates a delay in the onset of type 2 diabetes and cardiovascular events among individuals with the metabolic syndrome.     

Cardiovascular risk associated with the metabolic syndrome

The term metabolic syndrome refers to a clustering of cardiovascular risk factors, most of which also share insulin resistance as an additional feature. Scientific effort has concentrated on understanding why these diverse cardiovascular risks co-occur in individuals and in determining the presumed common environmental or genetic factors that might underpin this. Clinically important developments include publication of standard definitions of the metabolic syndrome and recommendations for the use of type 2 diabetes and the presence of the metabolic syndrome as critical "risk stratifiers" in cardiovascular disease prevention. The remarkable recent secular increases in the prevalence of type 2 diabetes and obesity in many populations mean that the importance of the metabolic syndrome as a determinant of cardiovascular disease is likely to increase until these trends can be reversed.     

High prevalence of metabolic syndrome among young women with premature coronary artery disease

BACKGROUND: The metabolic syndrome is more prevalent with the use of the recently defined National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria and is associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. This study evaluated the prevalence of metabolic syndrome in female and male patients with newly diagnosed premature coronary artery disease. METHOD: The study population included 582 consecutive patients (496 men, 86 women) with newly diagnosed premature coronary artery disease (aged < or =45 years). Besides classic major coronary risk factors, all patients were evaluated for the presence of metabolic syndrome based on the NCEP ATP III criteria. RESULTS: The majority of patients were male (85% versus 15%). The overall prevalence of metabolic syndrome was 37%. Women with premature coronary artery disease were found to have a higher prevalence of metabolic syndrome than men (73% versus 31% respectively, p < 0.001). Furthermore, the mean number of components of metabolic syndrome was significantly higher in women compared to men (2.81 +/- 1.09 versus 1.85 +/- 1.08 respectively, p < 0.001). In addition, metabolic syndrome was detected to be the most frequent coronary risk factor in women (73%). Besides, cigarette smoking was found to be significantly higher in males compared to females (70% versus 36% respectively, p < 0.001) and it was the most prevalent coronary risk factor in men with premature coronary artery disease. CONCLUSION: We have shown for the first time a higher prevalence of metabolic syndrome in young females compared with young males with premature coronary artery disease. This data may be useful in directing primary and secondary preventive measures.     

Relation of aging and sex hormones to metabolic syndrome and cardiovascular disease

Several factors such as age, gender, race, lifestyle and diet, contribute to the prevalence of the metabolic syndrome, which has become the new epidemic of this century. They also contribute to the prevalence, age of appearance and outcome of cardiovascular disease, which is the number one cause of morbidity and mortality in men and women worldwide. Metabolic syndrome increases the risk of developing cardiovascular diseases, hypertension and type-2 diabetes, among other diseases. In this paper we analyze from a pathogenetic point of view, two of the factors which contribute to the increasing prevalence of the metabolic syndrome and cardiovascular diseases: age and gender. The gender variations are a consequence of the different rate of decrease of sexual hormones in males and females and of the protective roles they play during adulthood and older age phases.     

成渝地区中老年人群代谢综合征流行病学特征及其相关因素

目的探讨成渝地区中老年人群代谢综合征流行病学特征及其相关危险因素。方法于2013年采用分层整群抽样的方法,调查成渝城乡地区40~79岁中老年人7807例,进行身高、体重、血压、血脂及口服葡萄糖耐量试验(OGTT)等检测。用统一设计的调查表对研究对象进行面对面的问卷调查。代谢综合征诊断标准采用中华医学会糖尿病学分会标准。结果成渝地区中老年人群代谢综合征患病率为13.8%。男性患病率为13.3%,女性患病率为14.1%,两性患病率无统计学差异。城区患病率为14.6%,农村患病率为10.6%,城市患病率高于农村。40~69岁研究人群代谢综合征患病率逐渐升高。年龄、腹型肥胖、缺乏体育锻炼是成渝地区中老年男性代谢综合征主要的危险因素;年龄、一级亲属高血压病史、腹型肥胖是成渝地区中老年女性代谢综合征主要的危险因素。结论成渝地区中老年人群代谢综合征患病率较高。控制合理的腰围,对于人群代谢综合征的预防、干预以及阻止心血管疾病的发生发展可能有重要意义。     

Definition of the Metabolic Syndrome: What's New and What Predicts Risk?

The metabolic syndrome is a clustering of abnormalities that confers an increased risk of cardiovascular disease and type 2 diabetes. Five organizations have proposed definitions of the syndrome. Despite differences in specific criteria among the definitions, there is agreement that the major characteristics of the syndrome include central obesity (except in one definition), elevated blood pressure, dyslipidemia, and impaired glucose metabolism or insulin resistance. Large variations exist in the prevalence of the metabolic syndrome across countries and regions, ethnic groups, and gender. The prevalence is high and increasing, particularly in North and South American countries. The high prevalence, combined with the large number of people at risk for cardiovascular disease, type 2 diabetes, and other related disorders, suggests that the metabolic syndrome may present a major worldwide public health challenge in future.     

Metabolic syndrome in children and adolescents

Opinion statement Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin that often accompany obesity and consist of atherogenic dyslipidemia, elevated blood pressure, impaired glucose tolerance, a prothrombotic state, and a proinflammatory state. Using a modification of the criteria by the National Cholesterol Education Program Adult Treatment Panel III, metabolic syndrome in children and adolescents can be clinically diagnosed when three or more of the following are present: body mass index ≥ 2 z score, systolic or diastolic blood pressure greater than 95th percentile, triglyceride level greater than 95th percentile, and/or high-density lipoprotein cholesterol less than 5th percentile and impaired glucose tolerance (fasting glucose > 110 mg/dL [6.1 mmol/L]). The prevalence of the metabolic syndrome in adolescents has been shown to be 4% overall, but it is 30% to 50% in overweight adolescents. In the United States, 18% to 22% of children and adolescents are overweight; the prevalence of a metabolic syndrome phenotype among US adolescents has also been increasing significantly over the past decade. All of the features of metabolic syndrome are risk factors for atherosclerosis, and metabolic syndrome has been shown to constitute risk for atherosclerotic cardiovascular disease in adults. In children and adolescents with metabolic syndrome, biomarkers of an increased risk of adverse cardiovascular outcomes are already present. Therefore, there is need for prevention and treatment of metabolic syndrome in this population. The mainstay of the treatment is dietary intervention and promotion of active lifestyle to achieve and maintain optimum weight, normal blood pressure, and normal lipid profile for the height and age. The pharmaceutical intervention is usually not required and its long-term outcome has not been studied. There is need for large studies for the management and long-term outcomes of metabolic syndrome in children and adolescents if the future tides of cardiovascular and other associated complications of metabolic syndrome are to be turned around.     

What are the risk factors and settings for non‐alcoholic fatty liver disease in Asia–Pacific?

The risk factors and settings for non-alcoholic fatty liver disease (NAFLD) in Asians are reviewed comprehensively. Based particularly on large community-based studies using ultrasonography, case-control series and prospective longitudinal studies, the prevalence of NAFLD in Asia is between 12% and 24%, depending on age, gender, locality and ethnicity. Further, the prevalence in China and Japan has nearly doubled in the last 10-15 years. A detailed analysis of these data shows that NAFLD risk factors for Asians resemble those in the West for age at presentation, prevalence of type 2 diabetes mellitus (T2DM) and hyperlipidemia. The apparent differences in prevalence of central obesity and overall obesity are related to criteria used to define waist circumference and body mass index (BMI), respectively. The strongest associations are with components of the metabolic syndrome, particularly the combined presence of central obesity and obesity. Non-alcoholic fatty liver disease appears to be associated with long-standing insulin resistance and likely represents the hepatic manifestation of metabolic syndrome. Not surprisingly therefore, Asians with NAFLD are at high risk of developing diabetes and cardiovascular disease. Conversely, metabolic syndrome may precede the diagnosis of NAFLD. The increasing prevalence of obesity, coupled with T2DM, dyslipidemia, hypertension and ultimately metabolic syndrome puts more than half the world's population at risk of developing NAFLD/non-alcoholic steatohepatitis/cirrhosis in the coming decades. Public health initiatives are clearly imperative to halt or reverse the global 'diabesity' pandemic, the underlying basis of NAFLD and metabolic syndrome. In addition, a perspective of NAFLD beyond its hepatic consequences is now warranted; this needs to be considered in relation to management guidelines for affected individuals.     

Comparison of different metabolic syndrome definitions and risks of incident cardiovascular events in the elderly

The metabolic syndrome is associated with increased cardiovascular risk, and its prevalence increases with age. Various definitions of the metabolic syndrome exist, but whether some definitions are more predictive of future cardiovascular events in the elderly is unclear. We compared the risk of incident cardiovascular events in elderly individuals at least 65 years old from the Cardiovascular Health Study with and without the metabolic syndrome as defined by the European Group for the Study of Insulin Resistance (EGIR), National Cholesterol Education Program (NCEP)/American Heart Association (AHA), American Association of Clinical Endocrinologists, International Diabetes Federation (IDF), and modified World Health Organization (WHO) criteria (n = 3390). Participants were without baseline diabetes or cardiovascular disease. Except for EGIR, all definitions of the metabolic syndrome were significantly associated with increased risk of incident cardiovascular (coronary or cerebrovascular) events. Adjusted hazard ratios (HRs) for risk of incident cardiovascular events as defined by the modified WHO, NCEP/AHA, American Association of Clinical Endocrinologists, and IDF criteria ranged from 1.153 (P = .045) for NCEP/AHA to 1.314 (P < .001) for IDF, with 95% confidence interval (CI) ranging from 1.003 to 1.503. Adjusted HR for EGIR was 1.087 (95% CI, 0.908-1.301; P = .362). Similarly, all definitions of the metabolic syndrome were significantly associated with incident coronary events except for the EGIR definition. Only the modified WHO definition was associated with increased risk for cerebrovascular events (adjusted HR, 1.301; 95% CI, 1.038-1.631; P = .022). Although all metabolic syndrome definitions except EGIR were associated with total cardiovascular events and coronary events, only the modified WHO definition was also associated with risk of cerebrovascular events.     

The prevalence of metabolic syndrome in postmenopausal women: A systematic review and meta-analysis in Iran

Metabolic syndrome is a set of cardiovascular risk factors that increase the risk of cardiovascular disease, diabetes and mortality. Women are at risk of developing metabolic syndrome as they enter the postmenopausal period. The present systematic review and meta-analysis was conducted to estimate the prevalence of metabolic syndrome in Iranian postmenopausal women. In this systematic review and meta-analysis, 16 national articles published in Persian and English were gathered without time limit. National databases such as SIDs, IranMedex and MagIran, and international databases such as Web of Science, Google Scholar, PubMed and Scopus were used to search the relevant studies. We searched for articles using the keywords “menopause”, “postmenopausal”, “metabolic syndrome”, “MetSyn”, and their combinations. Data were analyzed using the meta-analysis method and the random effects model. Analysis of 16 selected articles with a sample size of 5893 people showed that the prevalence of metabolic syndrome in Iranian postmenopausal women was 51.6% (95% CI: 43–60). The prevalence of metabolic syndrome based on ATP III and IDF criteria was 54% (95% CI: 59–63) and 50% (95% CI: 45–56), respectively. Based on the results of univariate meta-regression analysis, the increase in the mean age of postmenopausal women (p?=?0.001) and sample size (p?=?0.029), the prevalence of metabolic syndrome increased significantly. More than half of postmenopausal women in Iran suffer from metabolic syndrome. Providing training programs for postmenopausal women to prevent and control cardiovascular disease and its complications seems to be necessary.     

Prevalence of metabolic syndrome in Pakistan

Over the past two decades, there has been a striking increase in the number of people with metabolic syndrome. The prevalence of metabolic syndrome varies due to lack of an internationally agreed upon definition. Considering the increased cardiovascular risk among Asian people, a lower cutoff for waist circumference is defined. Obesity in terms of waist circumference is found to be 46-68% of the Pakistani population, with a strong association found between arm fat and insulin insensitivity. In studying dyslipidemia, hypertriglyceridemia is found in 27-54% of the population, whereas 68-81% have low levels of high-density lipoprotein (HDL). Fifty percent were found to be at high risk of metabolic syndrome and as being hypertensive. With the high prevalence of all of these metabolic risk factors, the prevalence of metabolic syndrome in Pakistan according to different definitions is reported to be from 18% to 46%, comparable to the data from other South Asian countries. Thus, metabolic syndrome should be considered as a prime target for preventive medicine. The primary management goals for metabolic syndrome are to reduce the risks of cardiovascular disease and diabetes. Lifestyle-related risk factors are associated with the metabolic syndrome and diabetes. Unless preventive programs are properly designed and implemented, we will continue to treat the majority of the cases after they have already developed the complications. A prospective primary prevention study is underway in Pakistan that will help to create a base for public awareness strategies and nationwide surveillance and prevention programs against noncommunicable diseases.     

Metabolic syndrome, subclinical coronary atherosclerosis, and cardiovascular risk

The metabolic syndrome is a constellation of cardiovascular disease risk factors, and it is associated with the presence of advanced subclinical coronary atherosclerosis. The presence of the metabolic syndrome appears to provide incremental predictive value on top of the Framingham risk score in predicting future cardiovascular events. Traditional risk-prediction formulas fail to account for a significant portion of coronary heart disease morbidity and mortality. The metabolic syndrome may be particularly useful in predicting risk among individuals classified as low or intermediate risk by Framingham risk score.