Cardiovascular risk and the metabolic syndrome

Clustering of metabolic syndrome (MetS) components within individuals helps in the identification of subjects who are at increased risk for both cardiovascular disease (CVD) and diabetes. In this review we describe how the presence of MetS influences CVD risk. Our review focuses on published studies through May 2006 referring to incident CVD in relation to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition of the MetS. We present data suggesting that the Framingham risk function is the most appropriate method for assessing CVD risk in subjects with or without MetS. We show how the CVD risk associated with MetS is influenced by the inclusion of subjects with diabetes and CVD at baseline, and by the development of diabetes during follow-up, and that this might explain why MetS may be a stronger risk factor for CVD in women than in men. We present data suggesting that CVD risk associated with MetS does not appear to be greater than the sum of its parts, and that adding CRP to MetS variables does not improve population CVD risk prediction. Lifestyle intervention and treatment of specific abnormal MetS components are appropriate until a better understanding of the pathogenesis of MetS is available. At such time we may be able to target the underlying causes of the syndrome and ultimately prevent the development of both CVD and diabetes.     

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.     

Cardiovascular risk and adrenergic overdrive in the metabolic syndrome

AimsThis paper will review the role of the sympathetic nervous system in the pathogenesis of the metabolic syndrome as well as its importance as target of non-pharmacologic and pharmacologic treatment.Data synthesisSeveral indices of adrenergic drive, such as plasma norepinephrine, norepinephrine spillover from adrenergic nerve terminals and efferent postganglionic muscle sympathetic nerve traffic, have all shown an increase in the different conditions clustering in metabolic syndrome, such as obesity, hypertension and insulin resistance state. This increase: 1) appears to be potentiated in the metabolic syndrome; and 2) contributes to a large extent at the cardiovascular structural and functional alterations typical of the disease. Based on this evidence, non-pharmacologic life-style interventions as well as drug treatment procedures used in the therapeutic approach to the metabolic syndrome should be aimed at exerting not only favourable haemodynamic and metabolic effects but also pronounced sympathoinhibition.ConclusionThe data reviewed in this paper strongly support the relevance of the sympathetic nervous system in the pathogenesis of the metabolic syndrome and the importance of the sympathomodulation as a specific aim of therapeutic intervention.     

Cardiovascular risk assessment in metabolic syndrome: view from PROCAM.

The near-epidemic proportions of diabetes mellitus and the metabolic syndrome over the past years are widely ascribed to a changing socioeconomic environment that contributes to excessive nutritional intake and sedentary lifestyle. Paradoxically, this gives room for expectations, because timely lifestyle and dietary intervention could decelerate the progression of diabetes, reduce the rate of development of cardiovascular complications, and reduce costs associated with treatment and rehabilitation. This approach,however, depends on the development of tools that allow precise estimation of risk of cardiovascular complications before the onset of diabetes mellitus and the risk of developing type 2 diabetes itself. This article reviews the progress that has been made toward reaching these goals based on the results of the PROspective Cardiovascular Münster (PROCAM) study.     

代谢综合征再认识及防治新思考

1　代谢综合征的命名沿革早在 1936年Himsworth已发现不同个体对胰岛素的反应性有很大差异 ,并首次提出部分糖尿病患者有“胰岛素不敏感”。 2 0世纪 6 0年代后期Avogaro及 1981年Henefeld均先后报道了代谢综合征 (metabolicsyndrome ,MS)但未引起重视。直到 1988年Reaven发表了以胰岛素抵抗 (IR)为题的文章后 ,MS很快成为临床和基础研究的热点。1988年Reaven在总结前人研究成果的基础上 ,提出了著名的“X综合征”的名称 ,发现胰岛素抵抗不仅为糖尿病的特征 ,同时还普遍存在于人类多种疾病的病理状态中 ,包括 :(1)组织对胰岛素介导的葡…     

Cardiovascular risk,atherosclerosis and metabolic syndrome after liver transplantation: a mini review

Liver transplantation is the standard of care for acute and chronic end-stage liver disease. Advances in medical therapy and surgical techniques have transformed the long-term survival of liver-transplant (LT) recipients. The prevalence of post-transplant cardiovascular complications has been rising with increased life expectancy after liver transplantation. Currently, deaths related to cardiovascular complications are one of the main causes of long-term mortality in LT recipients, as cardiovascular disease is the reason of 19–42% of non-liver-related mortality after transplant. On the other hand, metabolic syndrome is common among LT recipients before and after transplantation. In fact, their components (abdominal obesity, diabetes mellitus, hypertension and dyslipidemia) are often exacerbated by transplant-specific factors, such as immunosuppression, inappropriate diet, smoking and a sedentary lifestyle, and add a significant risk of developing atherosclerosis. These aspects are discussed in this article.     

The prevention and treatment of metabolic syndrome and high-risk obesity

PURPOSE OF REVIEW: The prevalence of obesity is increasing at an alarming rate, and the obesity epidemic is driving the epidemic in type 2 diabetes. High-risk obesity is characterized by abdominal obesity with evidence of abnormal glucose and lipid metabolism, and a state of heightened inflammation. RECENT FINDINGS: With increasing body weight, lipid accumulation occurs not only in adipose tissue, but in other organs as well. This 'lipotoxicity' in liver, muscle, islets, and elsewhere may account for many of the features of the metabolic syndrome. Adipose tissue produces many proteins, some of which are inflammatory cytokines, and others of which are antiinflammatory or which improve insulin sensitivity. SUMMARY: The treatment of obesity requires the identification of the high-risk patient, and the institution of lifestyle measures with a long-term outlook, and an avoidance of heavily marketed fads. Current research will likely lead to improved medications in the future.     

对代谢综合征防治模式的新思考

代谢综合征(MS)是一组由环境因素与遗传因素共同作用导致的临床综合征,是动脉粥样硬化性心血管疾病(CVD)和2型糖尿病的重要危险因素。由于生活方式的改变、饮食过剩、生活节奏的加快、体育锻炼的缺乏等,该病的发病率已越来越高,并成为现代人生命健康的杀手,被称为“世纪流行病”。我国的最近统计资料显示,20岁以上成年人中MS的患病率达9·8%~17·8%,发病年龄已不再局限于中老年人。1MS的定义迄今为止,MS的定义意见尚未统一。目前国际上广泛应用的主要有来自2个领域的标准:来自心血管领域的是2001年美国国家胆固醇教育计划成人治疗指南…     

The metabolic syndrome: prevalence, CHD risk, and treatment

An increased risk of coronary heart disease (CHD) morbidity and mortality is associated with the metabolic syndrome, a condition characterized by the concomitant presence of several abnormalities, including abdominal obesity, dyslipidemia, hypertension, insulin resistance (with or without glucose intolerance or diabetes), microalbuminuria, prothrombotic, and proinflammatory states. Estimates of the prevalence of the metabolic syndrome indicate that this condition is now common and likely to increase dramatically over the coming decades, in parallel with greater rates of obesity and Type 2 diabetes. Risk factors for the metabolic syndrome are already present in obese children and adolescents. Thus, identifying and treating all affected individuals promptly and optimally are critical to ensure that this potentially challenging healthcare burden is minimized. Here, we review the prevalence of the metabolic syndrome, dyslipidemias, and CHD risk. Although changes in lifestyle are fundamental to reducing many of the CHD risk factors associated with the metabolic syndrome, pharmacologic interventions also play an important role. Retrospective subanalyses of the effects of statins on coronary event rates and lipid levels in patients with the metabolic syndrome included in clinical trials indicate that these agents are beneficial in correcting the extensive lipid abnormalities that are frequently present in these individuals. However, the optimal management of metabolic syndrome dyslipidemia will depend on the outcomes of future prospective clinical trials. This review examines the underlying causes and prevalence of the metabolic syndrome and its impact on CHD morbidity and mortality and discusses the role of statins in optimizing its management.     

The metabolic syndrome and mortality: the Singapore Cardiovascular Cohort Study

Objective  This study assesses the effect of the metabolic syndrome on all-cause and cardiovascular disease (CVD) mortality in healthy Chinese, Malays and Asian Indians in Singapore. The utility of the metabolic syndrome is also compared with the Framingham risk score for prediction of mortality.
Methods  Healthy participants ( n  = 5699) were grouped by the presence or absence of the metabolic syndrome, and followed up (mean 14·1 years) by data linkage with the National Death Register. Risk of mortality was obtained by Cox's proportional hazards model with adjusted hazard ratios (HRs). Area under receiver operating characteristic (ROC) curves were used to compare the metabolic syndrome and Framingham risk score for prediction of mortality.
Results  During a follow-up of 80 236 person-years, there were 382 deaths, of which 128 were due to CVD. Individuals with the metabolic syndrome had an increased risk of mortality for 'all-causes' (males: HR 1·4, 95% confidence intervals (95%CI) 1·1–1·8; and females: HR 1·8, 95%CI 1·3–2·6). There was also an increased risk of mortality due to CVD (males: HR 3·0, 95%CI 1·9–4·8; and females: HR 2·1, 95%CI 1·1–4·0). The area under ROC for Framingham risk score was higher for both all-cause and CVD mortality than metabolic syndrome.
Conclusions  Although an increased risk of 'all-cause' and CVD mortality due to the metabolic syndrome was found, the Framingham risk function still performed better than the metabolic syndrome in an Asian population. However, the metabolic syndrome should not be disregarded as it is a clinically useful entity for identifying individuals for management of its component CVD risk factors.     

Cardiovascular risk assessment in patients with type 2 diabetes mellitus and metabolic syndrome: Role of biomarkers

ObjectivesMetabolic syndrome (MetS) and type 2 diabetes mellitus (DM) are associated with a high incidence of cardiovascular diseases. The aim of this study was to determine paraoxonase (PON), total sialic acid (TSA), and nitric oxide (NO) levels in addition to conventional risk markers in patients with DM, MetS and DM plus MetS.Material and methodsThe study has been carried out over 78 subjects which divided into four groups; control (n = 18), DM (n = 20), newly diagnosed MetS (n = 20) and DM plus MetS patient groups (n = 20).ResultsBoth insulin and triglyceride concentrations were significantly higher in DM + MetS group than in control and DM groups and serum HDL-C concentrations were significantly lower in DM + MetS group than other groups. Patients with MetS had higher LDL-C, total cholesterol and hsCRP concentrations than in the other groups. Interestingly, in addition to body mass index and waist circumference values, LDL-C, total cholesterol and hsCRP concentrations were decreased in patients who have both DM and MetS. Serum NO and TSA levels were higher in MetS and DM + MetS groups compared to control subjects. Unexpectedly, PON activity has been found lower in control group when compared to other groups.ConclusionsAlthough there is no doubt that association of DM and MetS elevates the risk of cardiovascular disease, occurrence of DM in patients with undiagnosed MetS might be encouraging patients to change their life styles and dietary habits.     

Intensified screening and treatment of the metabolic syndrome for cardiovascular risk reduction

The metabolic syndrome (MetS), characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, is associated with an increased risk of coronary heart disease and cardiovascular disease mortality. Persons with MetS have a wide spectrum of coronary heart disease risk and appropriate evaluation of risk using global risk algorithms. Measurement of other risk markers and subclinical disease is potentially needed to best set treatment goals and accompanying treatment regimens. The presence of MetS risk factors should be considered in global risk assessment. Clinical management emphasizes addressing underlying risk factors predisposing to MetS-specifically overweight/obesity and physical inactivity. Further recommendations are given for clinical risk factors, including atherogenic dyslipidemia, elevated blood pressure, insulin resistance/hyperglycemia, prothrombotic state, and proinflammatory state. Clinicians are recommended to assess MetS in their routine practice and to intensify efforts to adequately treat accompanying lifestyle and clinical risk factors.     

Cardiovascular disease risk of type 2 diabetes mellitus and metabolic syndrome: focus on aggressive management of dyslipidemia

Type 2 diabetes mellitus and the closely related metabolic syndrome markedly increase the risk of cardiovascular disease a major contributor is the dyslipidemia. Recent studies and new national guidelines suggest these very high risk patients with cardiovascular disease achieve optional low density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dl. In addition there may be no threshold to begin therapeutic lifestyle change and pharmacologic therapy to reduce LDL-C by 30-40%. Although randomized controlled trials with statins indicate that LDL reduction clearly reduces cardiovascular risk in these patients, the typical dyslipidemia of type 2 diabetes mellitus is also characterized by low high density lipoprotein cholesterol (HDL-C) levels, increased triglyceride-rich lipoproteins and small dense LDL, as well as increased postprandial lipemia. The later lipoproteins increase non-HDL-C levels. In order to address these abnormalities it may be necessary to utilize combined approaches with a fibrate or nicotinic acid, or other agents with statins to help reduce risk beyond statins. In addition, supervised, therapeutic life-style change is often underutilized therapy in patients with established coronary artery disease. This review will focus on maximizing the treatment of dyslipidemia in type 2 diabetes and the metabolic syndrome and discuss the evidence based studies and new developments in the management in these very high risk patients.     

老年人代谢综合征与心脑血管事件

代谢综合征(MS)是一组以肥胖、高血糖、血脂异常以及高血压等聚集发病、严重影响人类健康的临床症候群.代谢综合征在老年人群中具有较高的患病率,其所引发的多种代谢异常都是老年人心脑血管事件的重要危险因子,严重影响老年人的身心健康.     

Cardiovascular risk factors are really linked in the metabolic syndrome: this phenomenon suggests clustering rather than coincidence

BACKGROUND: The accumulation of cardiovascular risk factors can be seen in a single person but it needs to be determined if this occurs more frequently than might be explained by mere coincidence. METHODS: This study involved 119,412 adults: 41,819 males and 77,593 females, who were 40 years of age or older and who underwent an annual health examination. From the clinical and biochemical data, the actual prevalence of a combination of 3 or more factors: abnormal body mass index (> or =25.0), hypertension, high triglyceride (> or =150 mg/dl), low HDL cholesterol (<40 mg/dl) and abnormal fasting glucose metabolism (fasting blood sugar > or =110 mg/dl or HbA1c. > or =5.5%) was determined. Then, the prevalence of a corresponding combination of 3-5 factors was predicted from the prevalence of each factor on the assumption that their combination occurs as a result of coincidence. RESULTS: The criteria of metabolic syndrome (> or =3 risk factors) was met in 17,842 (14.9%) of the examinees. The actual prevalence of any combination of 3-5 factors of metabolic syndrome was more frequent than those expected to occur by coincidence (P < 0.001). When compared with the prevalence of the total examinees, the prevalence of obesity and insulin resistance was 2.5 and 2.9 times higher in metabolic syndrome compared to that in the total examinees but it was 1.7 to 2.1 times higher in hypertension and high triglyceride. The former two were clustering more than hypertension or high triglyceride in metabolic syndrome. Abnormal levels of serum creatinine and total cholesterol were found more often in metabolic syndrome. CONCLUSION: Combinations of risk factors of metabolic syndrome were found more frequently than coincidental phenomenon in the subjects from the general population. These finding suggest that these risk factors do cluster and obesity and insulin resistance were suggested to be linked with metabolic syndrome more than hypertension or high triglyceride.