Therapeutic approaches in the prevention of cardiovascular disease in metabolic syndrome and in patients with type 2 diabetes.
OBJECTIVE
The metabolic syndrome is commonly encountered in the United States. It has been estimated from a survey conducted nearly a decade ago that one in four American adults fulfill the criteria for the metabolic syndrome. As obesity has become more common, the prevalence of type 2 diabetes has increased, and these trends can be expected to translate into more cardiovascular disease in future years. The high cardiovascular risk that accompanies the metabolic syndrome and type 2 diabetes mandates comprehensive and aggressive preventive care. This article reviews evidence that treatments directed at the individual components of the metabolic syndrome will delay the progression to type 2 diabetes and will reduce the incidence of cardiovascular disease.


RESULTS
In overweight individuals with the metabolic syndrome, the onset of type 2 diabetes can be delayed by therapeutic lifestyle changes (weight loss and exercise), insulin sensitizers (metformin, troglitazone), angiotensin converting enzyme inhibitors (captopril, fosinopril, ramipril), and angiotensin receptor blockers (losartan, candesartan). Lipid altering therapies (statins, fibrates, and niacin) are especially efficacious for reducing cardiovascular events in metabolic syndrome and type 2 diabetes patients.


CONCLUSIONS
An aggressive multifactorial approach to cardiovascular risk factor modification facilitates a delay in the onset of type 2 diabetes and cardiovascular events among individuals with the metabolic syndrome.
Rosenson
Robert S
RS
Preventive Cardiology Center, Division of Cardiology, Departments of Medicine and Preventive Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. r-rosenson@northwestern.edu
Reasner
Charles A
CA
D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002995:Clofibric Acid / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002995:Clofibric Acid