The metabolic syndrome: diagnosis and treatment.

The metabolic syndrome is a clustering of risk factors that, in the aggregate, sharply increase the risk of cardiovascular disease (CVD). The syndrome is characterized by abdominal obesity, a characteristic atherogenic dyslipidemia, hypertension, insulin resistance with or without hyperglycemia, a prothrombotic state, and a proinflammatory state. CVD is the most important clinical sequela of the metabolic syndrome. The syndrome also carries a greatly increased risk for development of type 2 diabetes mellitus, which in turn increases cardiovascular risk even further. Conventional risk formulas may underestimate actual CVD risk in metabolic syndrome patients because of their concentration of nontraditional risk factors. Management of the metabolic syndrome should focus on weight loss, increased physical activity, and improvement of atherogenic diet. Pharmacologic therapy for lipids and blood pressure will be needed in most cases. The atherogenic dyslipidemia includes high triglyceride, low high-density lipoprotein cholesterol levels and small, dense low-density lipoprotein cholesterol particles. Management should allow for statin in virtually all cases, accompanied by a triglyceride-lowering agent in many cases. Hypertension should be managed aggressively, with a blood pressure target of 130/80 mm Hg. Multiple agents are usually required to treat hypertension. Simultaneous management of multiple risk factors has the potential to greatly reduce the incidence of CVD in individuals with the metabolic syndrome.