title: A practical "ABCDE" approach to the metabolic syndrome.
abstract: The metabolic syndrome comprises a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus that are due to abdominal obesity and insulin resistance. This increasingly important proinflammatory condition remains both underrecognized and undertreated. To aid physicians in their approach to the metabolic syndrome, we assessed and synthesized the literature on cardiovascular risk assessment and early intervention for risk reduction. We performed a comprehensive search of MEDLINE and the Cochrane database for peer-reviewed clinical studies published from January 1, 1988, to December 31, 2007, augmented by consultation with content experts. We used the search terms metabolic syndrome, abdominal obesity, waist circumference, insulin resistance, cardiovascular disease, prediabetes, diabetes, treatment, prevention, aspirin, hypertension, cholesterol, atherogenic dyslipidemia, lifestyle therapy, diet, and exercise. Criteria used for study review were controlled study design, English language, relevance to clinicians, and validity based on experimental design and appropriateness of conclusions. Although growing evidence supports early intervention in patients with the metabolic syndrome, many physicians do not recognize the risk associated with this condition and fail to initiate early treatment. A comprehensive management plan can be assembled through an "ABCDE" approach: "A" for assessment of cardiovascular risk and aspirin therapy, "B" for blood pressure control, "C" for cholesterol management, "D" for diabetes prevention and diet therapy, and "E" for exercise therapy. This ABCDE approach provides a practical and systematic framework for encouraging metabolic syndrome recognition and for implementing a comprehensive, evidence-based management plan for the reduction of cardiovascular risk.
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524C, Division of Cardiology, 600 N Wolfe St, Baltimore, MD 21287, USA. mblaha1@jhmi.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bansal
authors.forename: Rosanne
authors.initials: R
authors.lastname: Rouf
authors.forename: Sherita H
authors.initials: SH
authors.lastname: Golden
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Defilippis
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000517:prevention & control; D004035:Diet Therapy; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin