Daskalopoulou S S, Mikhailidis D P, Elisaf M
Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, London, UK.
Angiology. 2004 Nov-Dec;55(6):589-612. doi: 10.1177/00033197040550i601.
The prevalence of the metabolic syndrome is increasing owing to lifestyle changes leading to obesity. This syndrome is a complex association of several interrelated abnormalities that increase the risk for cardiovascular disease and progression to diabetes mellitus (DM). Insulin resistance is the key factor for the clustering of risk factors characterizing the metabolic syndrome. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III defined the criteria for the diagnosis of the metabolic syndrome and established the basic principles for its management. According to these guidelines, treatment involves the improvement of the underlying insulin resistance through lifestyle modification (eg, weight reduction and increased physical activity) and possibly by drugs. The coexistent risk factors (mainly dyslipidemia and hypertension) should also be addressed. Since the main goal of lipid-lowering treatment is to achieve the NCEP low-density lipoprotein cholesterol (LDL-C) target, statins are a good option. However, fibrates (as monotherapy or in combination with statins) are useful for the treatment of the metabolic syndrome that is commonly associated with hypertriglyceridemia and decreased high-density lipoprotein cholesterol (HDL-C) levels. The blood pressure target is < 140/90 mm Hg. The effect on carbohydrate homeostasis should possibly be taken into account in selecting an antihypertensive drug. Patients with the metabolic syndrome commonly have other less well-defined metabolic abnormalities (eg, hyperuricemia and raised C-reactive protein levels) that may also be associated with an increased cardiovascular risk. It seems appropriate to manage these abnormalities. Drugs that beneficially affect carbohydrate metabolism and delay or even prevent the onset of DM (eg, thiazolidinediones or acarbose) could be useful in patients with the metabolic syndrome. Furthermore, among the more speculative benefits of treatment are improved liver function in nonalcoholic fatty liver disease and a reduction in the risk of acute gout.
由于生活方式改变导致肥胖，代谢综合征的患病率正在上升。该综合征是几种相互关联的异常情况的复杂组合，会增加心血管疾病风险以及发展为糖尿病（DM）的风险。胰岛素抵抗是代谢综合征特征性危险因素聚集的关键因素。美国国家胆固醇教育计划（NCEP）成人治疗小组（ATP）III定义了代谢综合征的诊断标准，并确立了其管理的基本原则。根据这些指南，治疗包括通过生活方式改变（如减重和增加体力活动）以及可能使用药物来改善潜在的胰岛素抵抗。同时存在的危险因素（主要是血脂异常和高血压）也应得到处理。由于降脂治疗的主要目标是达到NCEP低密度脂蛋白胆固醇（LDL-C）目标，他汀类药物是一个不错的选择。然而，贝特类药物（作为单一疗法或与他汀类药物联合使用）对于通常与高甘油三酯血症和高密度脂蛋白胆固醇（HDL-C）水平降低相关的代谢综合征的治疗是有用的。血压目标是<140/90 mmHg。在选择抗高血压药物时可能应考虑对碳水化合物稳态的影响。代谢综合征患者通常还有其他定义不太明确的代谢异常（如高尿酸血症和C反应蛋白水平升高），这些也可能与心血管风险增加有关。处理这些异常似乎是合适的。对碳水化合物代谢有有益影响并延迟甚至预防DM发作的药物（如噻唑烷二酮类或阿卡波糖）可能对代谢综合征患者有用。此外，治疗的更多推测性益处包括改善非酒精性脂肪性肝病的肝功能以及降低急性痛风的风险。
