Metabolic Syndrome (cont.)
Why should I know about metabolic syndrome?
Metabolic syndrome is worth caring about because it is a
condition that can pave the way to both diabetes and heart disease, two of the
most common and important chronic diseases today.
Metabolic syndrome increases the risk of type 2 diabetes (the common type of
diabetes) anywhere from 9-30 times over the normal population. That's a huge
increase. As to the risk of heart disease, studies vary, but the metabolic
syndrome appears to increase the risk 2-4 times that of the normal population.
There are other concerns as well that should be
mentioned. Metabolic syndrome is associated with fat accumulation in the liver
(fatty liver), resulting in inflammation and
the potential for cirrhosis. The kidneys can also be affected, as there is an
association with microalbuminuria -- the leaking of
protein into the urine, a subtle but clear indication of kidney damage.
Other problems associated with metabolic syndrome
include obstructive sleep apnea, polycystic ovary syndrome , increased risk of
dementia with aging, and cognitive decline in the elderly.
How is metabolic syndrome treated?
The major goals are to treat both the underlying cause
of the syndrome, and also to treat the cardiovascular risk factors if they persist. As has been
discussed, the majority of people with metabolic syndrome are overweight and
lead a sedentary lifestyle.
Lifestyle modification is the preferred treatment of metabolic syndrome.
Weight reduction usually requires a specifically tailored multifaceted program
that includes diet and exercise. Sometimes medications may be useful.
Diet
A detailed discussion of diet therapies, pros and cons of various diets etc.
is beyond the scope of this article. However, there is now a trend toward the
use of a Mediterranean diet -- one that is rich in
"good" fats (olive oil) and contains a
reasonable amount of carbohydrates and proteins (such as from fish
and chicken).
The Mediterranean diet is palatable and easily sustained. In addition, recent
studies have shown that when compared to a low fat diet, people on the
Mediterranean diet have a greater decrease in body weight, and also had greater
improvements in blood pressure, cholesterol levels, and other markers of heart
disease -- all of which are important in evaluating and treating metabolic
syndrome.
Exercise
A sustainable exercise program, fore example 30 minutes
five days a week is reasonable to start, providing there is no medical
contraindication. (If you have any special concerns in this regard, check with
your doctor first.) There is a beneficial effect of exercise on blood pressure,
cholesterol levels, and insulin sensitivity, regardless of whether weight loss is achieved or not. Thus,
exercise in itself is a helpful tool in treating metabolic syndrome.
Cosmetic surgery to remove fat
Some people may ask: Why not just have liposuction of
the abdomen and remove the large amount abdominal fat, which is a big part of the
problem? Data thus far shows no benefit in liposuction on insulin sensitivity,
blood pressure, or cholesterol. As the saying goes, "If it's too good to be
true, it probably is." Diet and exercise are still the preferred primary
treatment of metabolic
syndrome.
What if lifestyle changes are not enough to treat metabolic syndrome?
What if changes in lifestyle do not do the trick, what
then? Drugs to control
cholesterol levels, lipids, and high blood pressure may be considered.
If someone has already had a heart attack, their LDL
("bad") cholesterol should be reduced below 100mg/dl. (Some experts now say it
should be under 70mg/dl.) A person who has diabetes has a heart attack risk
equivalent to that of someone who has already one and so should be treated in
the same way. What remains controversial is whether metabolic syndrome should be
considered a coronary equivalent or not. If you have metabolic syndrome, a
detailed discussion about lipid therapy is needed between you and your doctor, as each individual is
unique.
Blood pressure goals are generally set lower than 130/80. Some blood pressure
medications offer more than simply lowering blood pressure. For example, a class
of blood pressure drugs called ACE inhibitors has been found to also reduce the
levels of insulin resistance and actually deter the development of type 2
diabetes. This is an important consideration when discussing the choice blood
pressure drugs in the metabolic syndrome.
The discovery that a drug prescribed for one condition, and has other
beneficial effects is not new. Drugs used to treat high blood sugar and insulin
resistance may have beneficial effects on blood pressure and cholesterol
profiles. A class of drugs called thiazolidinediones [pioglitazone
(Actos) and
rosiglitazone (Avandia)] also reduce the thickness of the walls of the carotid
arteries.
Metformin (Glucophage), usually used to treat type 2
diabetes, also has been found to help prevent the onset of diabetes in people with metabolic syndrome.
Indeed, in my practice, I routinely discuss metformin with my patients who have
metabolic syndrome. Many of my patients who have insulin resistance associated
with metabolic syndrome opt for metformin therapy. However, there are currently
no established guidelines on treating metabolic syndrome patients with metformin
if they do not have overt diabetes.
Next: Summary »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Glucose Tolerance Test - Glucose tolerance test, or the oral glucose tolerance test for making the diagnosis of diabetes, or more commonly, gestational diabetes.
- Diabetes - Learn about type 1 and 2 diabetes (Diabetes Mellitus) symptoms including increased urination, thirst, weight loss, fatigue, nausea, vomiting, skin infections, and blurred vision. Causes and diagnosis information is provided in the information.
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