الفهرس 
Metabolic SyndromeOnly 14 pages are availabe for public view
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Abstract
The metabolic syndrome consists of a constellation of factors that raise the risk for CVD and type 2diabetes. Because of the increasing prevalence of obesity, the metabolic syndrome has increased in frequency. ATP III introduced the metabolic syndrome into its clinical guidelines in the effort to achieve CVD risk reduction beyond LDL lowering therapy. Other clinical guidelines likewise have emphasized the need for more clinical attention to the metabolic syndrome. Although not all obese, sedentary persons acquire the metabolic syndrome, a significant subgroup of the population is susceptible to worsening of important contributors to the metabolic syndrome in the presence of energy imbalance. Several factors appear to contribute to this susceptibility, especially genetic predisposition and aging. Certain ethnic groups are particularly susceptible to the syndrome. Insulin resistance is a common feature of many of the components of the metabolic syndrome, and some investigators believe that it plays a key pathogenic role. Although genetic susceptibility is essential, the metabolic syndrome is relatively uncommon in the absence of obesity and physical inactivity. For this reason, lifestyle modification leading to weight reduction and increased physical activity represents first-line clinical therapy of the metabolic syndrome. Smoking cessation, of course, is paramount. A realistic goal for overweight/ obese persons is to reduce body weight by 7% to 10% over a period of 6 to 12 months. Weight reduction should be combined with a daily minimum of 30 minutes of moderate intensity physical activity. Nutritional therapy calls for a low intake of saturated fats, trans fats, and cholesterol; reduced consumption of simple sugars; and increased intakes of fruits, vegetables, and whole grains. Extremes in intakes of either carbohydrates or fats should be avoided. In addition, it was recognized that when genetic influences are particularly strong or when lifestyle changes fail to reduce risk sufficiently, drug therapy might be required to achieve treatment goals recommended in current guidelines. Particular attention must be given to adequately controlling the other major CVD risk factors: cigarette smoking, hypertension, elevated LDL cholesterol, and diabetes. Standard therapies for each apply in patients with the metabolic syndrome. Use of combination therapy with fibrates or nicotinic plus a statin is attractive for metabolic-syndrome patients with atherogenic dyslipidemia; even so, efficacy over statins alone has not been documented through clinical trials. Low-dose aspirin to modify the prothrombotic–pro-inflammatory state is justified for patients at intermediate risk and high risk. To date, management of insulin resistance with insulin-sensitizing agents in the absence of diabetes has not been shown to reduce CVD risk; therefore, they cannot be recommended for this purpose.