REVIEWA Practical “ABCDE” Approach to the Metabolic Syndrome
Section snippets
METHODS
We performed a comprehensive search of MEDLINE and the Cochrane database for clinical studies published from January 1, 1988, to December 31, 2007, using combinations of the following terms in their titles or abstracts: metabolic syndrome, abdominal obesity, waist circumference, insulin resistance, cardiovascular disease, prediabetes, diabetes, treatment, prevention, aspirin, hypertension, cholesterol, atherogenic dyslipidemia, lifestyle therapy, diet, and exercise. After screening the titles
MECHANISMS OF INCREASED RISK
The term metabolic syndrome evolved from observations that cardiovascular risk factors cluster in obese, insulin-resistant people; in its current use, it also refers to metabolically obese people of normal weight.18 The concept of the metabolic syndrome is useful because of its emphasis on underlying dysmetabolism and the attention it calls to co-existing cardiovascular risk factors.
Advances in adipocyte biology, subclinical inflammation, and oxidative stress have added to the original
DEFINITION OF THE METABOLIC SYNDROME
Clinical definitions of the metabolic syndrome use commonly measured patient data to identify people who are sufficiently insulin resistant to be at increased cardiovascular risk (Table 2). Although the World Health Organization, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and International Diabetes Federation definitions vary slightly, all identify a similar population of insulin-resistant people in need of risk modification. The conclusions of this review
CARDIOVASCULAR RISK PREDICTION
A diagnosis of metabolic syndrome allows early identification of patients with excessive adipose tissue and insulin resistance; as such, it can be considered a tool for the selection of patients who may have an increased lifetime risk of cardiovascular disease. Although the diagnosis should not be confused with a precise risk-scoring instrument, current definitions of the metabolic syndrome may identify a population of patients at greater cardiovascular risk than predicted by traditional risk
ABCDE APPROACH
In 2001, our center proposed an “ABC” approach to the implementation of ACC/American Heart Association (AHA) primary prevention guidelines,45 and we have since adopted an “ABCDE” approach to secondary prevention46 and the treatment of non-ST-segment elevation acute coronary syndromes.47 This review adapts this practical approach to the metabolic syndrome (Table 3).
CONCLUSION
An underrecognized and undertreated condition caused by abdominal obesity and insulin resistance, the metabolic syndrome predisposes people to the development of cardiovascular disease and diabetes. A clinical diagnosis of metabolic syndrome can be used as a tool to identify patients in need of comprehensive cardiovascular risk reduction therapy. A simple ABCDE approach is both easily accessible and comprehensive and can assist physicians by encouraging identification of patients with the
REFERENCES (117)
- et al.
Abdominal adiposity in U.S. adults: prevalence and trends, 1960-2000
Prev Med
(2004) Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds
J Am Coll Cardiol
(2006 Mar 21)- et al.
Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies
J Am Coll Cardiol
(2007 Jan 30) - et al.
The metabolic syndrome—a new worldwide definition
Lancet
(2005) - et al.
Adipose tissue as an endocrine organ
J Clin Endocrinol Metab
(2000) - et al.
The metabolic syndrome: concepts and controversy
Mayo Clin Proc
(2006) - et al.
Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease: a population-based study
J Am Coll Cardiol
(2007 May 29) - et al.
Association between metabolic syndrome and subclinical coronary atherosclerosis in asymptomatic adults
Am J Cardiol
(2004) - et al.
The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)
Am J Cardiol
(2004) - et al.
34th Bethesda Conference: Executive summary—can atherosclerosis imaging techniques improve the detection of patients at risk for ischemic heart disease?
J Am Coll Cardiol
(2003)
Metabolic syndrome: an appraisal of the pro-inflammatory and procoagulant status
Endocrinol Metab Clin North Am
Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial
Lancet
Correlation of non-high-density lipoprotein cholesterol with apolipoprotein B: effect of 5 hydroxymethylglutaryl coenzyme A reductase inhibitors on non-high-density lipoprotein cholesterol levels
Am J Cardiol
Medical significance of peroxisome proliferator-activated receptors
Lancet
Effectiveness and tolerability of simvastatin plus fenofibrate for combined hyperlipidemia (the SAFARI trial)
Am J Cardiol
Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin
J Am Coll Cardiol
Effect of short-term weight loss on the metabolic syndrome and conduit vascular endothelial function in overweight adults
Am J Cardiol
Diet and cardiovascular disease prevention the need for a paradigm shift [editorial]
J Am Coll Cardiol
A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women
Am J Clin Nutr
High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study
J Am Coll Cardiol
The effects of diet on inflammation: emphasis on the metabolic syndrome
J Am Coll Cardiol
Increasing trends in waist circumference and abdominal obesity among US adults
Obesity (Silver Spring)
Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey
JAMA
Increasing prevalence of the metabolic syndrome among U.S. adults
Diabetes Care
Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus
Circulation
Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes?
JAMA
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation
Diabet Med
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report
Circulation
Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112 (17):e297 and 2005;112 (17):e298]
Circulation
Rarer than a blue moon: the use of a diagnostic code for the metabolic syndrome in the U.S
Diabetes Care
Metabolic syndrome: is it a syndrome? does it matter?
Circulation
Does the metabolic syndrome exist?
Diabetes Care
The individual components of the metabolic syndrome: is there a raison d'etre?
J Am Coll Nutr
Clinical use of the metabolic syndrome: why the confusion?
Clin Diabetes
The metabolically obese, normal-weight individual revisited
Diabetes
Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation
Circulation
The new adipose tissue and adipocytokines
Curr Diabetes Rev
The role of adipocytokines and neurohormonal dysregulation in metabolic syndrome
Curr Diabetes Rev
Leptin signaling and obesity: cardiovascular consequences
Circ Res
The emerging role of the endocannabinoid system in endocrine regulation of energy balance
Endocr Rev
The suppressive effect of dietary restriction and weight loss in the obese on the generation of reactive oxygen species by leukocytes, lipid peroxidation, and protein carbonylation
J Clin Endocrinol Metab
Cardiovascular morbidity and mortality associated with the metabolic syndrome
Diabetes Care
The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men
JAMA
Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study
Circulation
Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in non-diabetic European men and women
Arch Intern Med
The metabolic syndrome and 11-year risk of incident cardiovascular disease in the Atherosclerosis Risk in Communities study
Diabetes Care
Abdominal adiposity and coronary heart disease in women
JAMA
Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies
Circulation
Measurement issues related to lipoprotein heterogeneity
Am J Cardiol
Is nondiabetic hyperglycemia a risk factor for cardiovascular disease? a meta-analysis of prospective studies
Arch Intern Med
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Dr Golden is a member of the Merck Clinical Diabetes Advisory Board.
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