Bragg Dee Ann Stults, Walling Anne
Department of Family and Community Medicine at the University of Kansas School of Medicine-Wichita, 707 N. Emporia, Wichita, KS 67214.
FP Essent. 2015 Aug;435:17-23.
Metabolic syndrome is associated with an elevated risk of cardiovascular disease and premature mortality. When metabolic syndrome includes lipid abnormalities, management goals are weight loss and cardiovascular risk management through lifestyle modifications (eg, diet, exercise), and, when appropriate, lowering of lipid levels with pharmacotherapy. Healthy diets are recommended, particularly the Mediterranean diet. Patients also should set a goal of at least 30 minutes of moderate to vigorous exercise on most, preferably all, days of the week. Guidelines provide criteria for statin treatment based on overall cardiovascular risk. High-intensity statin treatment (eg, rosuvastatin 20 to 40 mg, atorvastatin 40 to 80 mg) typically is recommended unless the patient cannot tolerate therapy. Approximately 5% of patients experience statin-induced myalgia, in which case moderate-intensity treatment can be tried. Lipid levels should be reevaluated 4 to 12 weeks after initiating therapy; lipid levels can be measured without fasting. A lack of improvement often indicates nonadherence. Bile acid sequestrants, fibric acids, and niacin can be used if other drugs are not tolerated. The evidence to support use of integrative medicine is limited, but the strongest evidence of benefit is for garlic (Allium sativum).
代谢综合征与心血管疾病风险升高和过早死亡相关。当代谢综合征包括脂质异常时，管理目标是通过生活方式改变（如饮食、运动）实现体重减轻和心血管风险管理，并在适当时通过药物治疗降低脂质水平。推荐健康饮食，尤其是地中海饮食。患者还应设定目标，每周大多数日子（最好是所有日子）进行至少30分钟的中等强度至剧烈运动。指南根据总体心血管风险提供他汀类药物治疗标准。通常推荐高强度他汀类药物治疗（如瑞舒伐他汀20至40毫克、阿托伐他汀40至80毫克），除非患者无法耐受治疗。约5%的患者会出现他汀类药物引起的肌痛，这种情况下可尝试中等强度治疗。开始治疗后4至12周应重新评估脂质水平；无需空腹测量脂质水平。改善不明显通常表明未坚持治疗。如果不能耐受其他药物，可使用胆汁酸螯合剂、贝特类药物和烟酸。支持使用整合医学的证据有限，但最有力的获益证据是大蒜（蒜）。
