| January 2005 · Vol. 17, No. 1 Feature article
Metabolic syndrome: When and how to intervene
Ob/Gyns are in a position to intervene early enough to make a difference in diabetes and heart disease risk—and intervention does reduce risk.
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Fast Track
Lipid abnormalities appear to account for much of the excess risk of metabolic syndrome
C-reactive protein levels tend to be higher in women than in men
Reduce LDL cholesterol to less than 100 mg/dL in women with metabolic syndrome
When LDL is 190 mg/dL or higher, use a combination of LDL-lowering drugs
Metabolic syndrome is linked to cognitive decline in the elderly
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Ronald
Krauss,
MDDirector, Atherosclerosis Research Children’s Hospital Oakland Research Institute
Oakland, Calif
Adjunct Professor, Department of Nutritional Sciences University of California,
Berkeley
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KEY POINTS
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First-line therapies for both lipid and nonlipid risk factors? Weight loss and regular exercise.
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Reduce low-density lipoprotein (LDL) cholesterol to less than 100 mg/dL when metabolic syndrome is present.
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Lower the total of LDL and very-low-density lipoprotein (VLDL) cholesterol to less than 130 mg/dL, especially in patients with borderline (150 to 199 mg/dL) or high (200 mg/dL or above) triglycerides.
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When drug intervention is needed to lower non-HDL cholesterol, use an LDL-lowering drug or add nicotinic acid or fibrate to reduce VLDL.
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Before you ask why another set of risk factors deserves your attention, consider this: Metabolic syndrome is a veritable epidemic, affecting at least 1 of every 5 patients. Among 60- to 69-year-olds, almost half the population meets the diagnostic criteria.1
This risk are serious. Metabolic syndrome amplifies morbidity and mortality due to diabetes mellitus and cardiovascular disease to such an extent that the National Cholesterol Education Program identifies it as a critical target of risk reduction, second only to reducing low-density lipoprotein (LDL) cholesterol.2
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