Hypolipidemic therapy for the metabolic syndrome.
The metabolic syndrome appears to affect a significant proportion of the population and is associated with increased risk for development of cardiovascular disease as well as of type-2 diabetes. No single treatment for the metabolic syndrome as a whole yet exists. While the primary management of patients with the metabolic syndrome involves healthy lifestyle promotion, the atherogenic dyslipidemia is a primary target for cardiovascular disease risk reduction in these patients. Statin therapy provides effective reduction of LDL-cholesterol, which represents the primary therapeutic goal of lipid-lowering therapy in patients at risk for cardiovascular disease. Fibrates in turn are effective in normalizing lipid levels (mainly triglycerides and HDL-cholesterol) in patients with the metabolic syndrome and may improve insulin resistance. Whereas statins remain the drug of choice for patients who need to achieve the LDL-cholesterol goal, fibrate therapy may represent an alternative for those with low HDL-cholesterol and high triglyceride levels. The simultaneous use of fibrates could be indicated in patients whose LDL-cholesterol is controlled by statin therapy but whose HDL-cholesterol and/or triglycerides are still inappropriate. Such a combination, however, needs careful monitoring due to the potential hazard of adverse drug interactions. Nicotinic acid and ezetimibe may be useful agents for therapy, particularly when combined with statins. A number of emerging therapies offer potential as future options for the pharmacological treatment of metabolic syndrome.
Cignarella
Andrea
A
Department of Pharmacological Sciences, University of Milan, via G. Balzaretti 9, I-20133 Milan, Italy. andrea.cignarella@unimi.it
Bellosta
Stefano
S
Corsini
Alberto
A
Bolego
Chiara
C
D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy*; D047493:PPAR alpha / Q000819:agonists
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D047493:PPAR alpha