Patient Care Endocrinology & Cardiology - October 2007 - (Page 10)

Recognizing and managing patients with the metabolic syndrome and prediabetes CONTRIBUTORS MARIA V. GIBSON, MD, PhD, Medical Director, University Family Medicine; and Assistant Professor, Department of Family Medicine, Medical University of South Carolina, Charleston. A. KESH HEBBAR, MD, Associate Professor, Department of Family Medicine, Medical University of South Carolina, Charleston. A Article at a glance I I I I IMAGE: JIM SHIVE The metabolic syndrome is a collection of clinical features that represents a multifactorial highrisk cardiovascular state and glucose intolerance. Its pathophysiology comprises 5 major metabolic risk factors: atherogenic dyslipidemia, hypertension, insulin resistance, and proinflammatory and prothrombotic states. The presence of 4 or 5 risk factors in men is associated with a 3.7-fold increase in coronary heart disease risk and a 24.5-fold increase for diabetes. All components of the metabolic syndrome can be improved by addressing the underlying risk factors with standard nonpharmacologic and pharmacologic approaches. 41-year-old woman presents to her primary care physician to follow up on her hypertension. Her family history is significant for both hypertension and diabetes. She does not smoke, has a sedentary lifestyle, and does not follow any particular diet. She is asymptomatic but has gained 10 lb during the last 12 months. The physical examination is essentially normal, aside from her weight of 102 kg (225 lb), a body mass index (BMI) of 42 kg/m2, and a waist circumference of 89 cm (35 in). Her BP is 131/80 mm Hg and is controlled on 25 mg of hydrochlorothiazide. Her fasting blood test results were as follows: serum glucose, 110 mg/dL; creatinine, 0.6 mg/dL; chloride, 100 mEq/L; sodium, 136 mEq/L; serum urea nitrogen, 12 mg/dL; CO2, 20 mEq/L; potassium, 4.3 mEq/L; LDL cholesterol (LDL-C) (direct), 112 mg/dL; triglycerides, 180 mg/dL; HDL cholesterol (HDL-C), 39 mg/dL. The patient is obese, has hypertension, and has elevated triglycerides, low HDL-C, and mildly elevated fasting glucose. Does she meet the criteria for metabolic syndrome? Is she at risk for diabetes mellitus (DM)? What additional workup is needed for evaluation? What therapy is most appropriate? DEFINITION The metabolic syndrome is a collection of clinical features that represents a multifactorial high-risk cardiovascular (CV) state and glucose intolerance. In 1988, Gerald M. Reaven published his first description of what he called syndrome X—a syndrome of insulin resistance and compensatory hyperinsulinemia associated with cardiac risk, to which he later added the features of hyperglycemia, hypertension, and dyslipidemia.1 In 1998, the World Health Organization (WHO) was the first organization to publish a definition of what we now call the metabolic syndrome, to be followed by the European Group for the Study of Insulin Resistance (EGIR) in 1999 and the National Cholesterol Education Program Adult Treatment Panel III (ATP III) in 2001.2-4 The American Association of Clinical Endocrinologists published their definition in 2003, referring to the disorder as the insulin resistance syndrome.5 In 2005, the American Heart Association (AHA)/National Heart, Lung, and Blood Institute made minor modifications to this definition.6 The 10 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - October 2007

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