Evaluating CMR

Etiology and treatment of the metabolic syndrome and its components according to the IDF

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The IDF recognizes atherogenic dyslipidemia as an important component of the metabolic syndrome. Dyslipidemic patients with the metabolic syndrome are characterized by a cluster of lipid abnormalities such as elevated triglyceride and apolipoprotein B concentrations as well as low HDL cholesterol. Hypertriglyceridemia has been shown to decrease both LDL and HDL particle size (8). The IDF proposed the same triglyceride and HDL cholesterol cut-off values as NCEP-ATP III and stated that other HDL cholesterol cut-off values may be required for women in certain populations (9). With respect to treating the atherogenic dyslipidemia of the metabolic syndrome, the IDF agrees that LDL cholesterol levels should be the primary target of therapy. Statins have been shown to significantly decrease LDL cholesterol levels and, more importantly, reduce the risk of a first or recurrent coronary heart disease (CHD) event (10). These compounds might also have other pleiotropic effects, such as reducing apolipoprotein B-containing lipoproteins and non-HDL cholesterol (VLDL, IDL, and LDL cholesterol) levels, which are also important therapeutic targets. Similarly, fibric acid derivatives can increase HDL cholesterol levels and reduce major coronary events incidence in patients with established CHD. Fibrate therapy may therefore be another compelling treatment for the atherogenic dyslipidemia of the metabolic syndrome (11).

In determining its clinical criteria for diagnosing the metabolic syndrome, the IDF suggested that high blood pressure is defined by systolic blood pressure ≥ 130 mm Hg and diastolic blood pressure ≥ 85 mm Hg or by treatment for hypertension. The IDF also states that while endothelial dysfunction and microalbuminuria are components of vascular dysregulation beyond elevated blood pressure, further research is needed to link these conditions to the metabolic syndrome. Regarding treatment of elevated blood pressure, the IDF supports national recommendations, i.e., drug therapy is required for patients with a blood pressure ≥ 140/≥ 90 mm Hg (12). No specific pharmacological treatment was proposed for elevated blood pressure.

Reference

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8. Carr MC and Brunzell JD. Abdominal obesity and dyslipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk. J Clin Endocrinol Metab 2004; 89: 2601-7.

9. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

10. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-52.

11. Robins SJ, Rubins HB, Faas FH, et al. Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Diabetes Care 2003; 26: 1513-7.

12. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-52.

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