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The European Society of Cardiology

The metabolic syndrome – a growing problem

A Tonkin*

Monash University, Melbourne, Vic., Australia

* Andrew Tonkin, MBBS, MD, FRACP, Department of Epidemiology and Preventive Medicine, Monash University, Level 3, 553 St. Kilda Road, Melbourne 3004, Vic., Australia. Tel.: +61-39903-0572; fax: +61-39903-0556
andrew.tonkin{at}med.monash.edu.au

Abstract

The metabolic syndrome is commonly defined as a group of risk factors or abnormalities closely associated with insulin resistance that markedly increase risk for both coronary heart disease and diabetes. Prospective cohort studies should help improve understanding of the relationships among the many risk factors identified as being part of the syndrome and may also improve the definition of the metabolic syndrome. According to the National Cholesterol Education Program definition, metabolic syndrome is estimated to be present in 24% of the US adult population, including 44% of those aged 50 years. With the World Health Organization definition, metabolic syndrome is present in 7–36% of European men and 5–22% of women aged 40–55 years. Abdominal adiposity appears to be a major driving force in metabolic syndrome and its increasing prevalence; adiposity is predictive of metabolic syndrome in population studies and is associated with a variety of metabolic derangements, including insulin resistance, increased systemic inflammation and decreased adiponectin levels. Lifestyle intervention with the goals of weight loss and increased exercise is a critical component of management aimed at preventing progression to diabetes and reducing cardiovascular risk. Lipid disorders in metabolic syndrome require aggressive management, with reduction of low-density lipoprotein cholesterol being a primary aim of lipid-lowering therapy in both metabolic syndrome and diabetes. However, increase in high-density lipoprotein cholesterol is also important. Intervention studies based on additional understanding of risk factors in metabolic syndrome will yield improved approaches to treating patients with the condition.

Key Words: Metabolic syndrome • Diabetes • Diabetes risk factors • Abdominal adiposity • Insulin resistance • Lipid disorders


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