Patient Care Endocrinology & Cardiology - October 2007 - (Page 16)

I Metabolic syndrome Patients with the metabolic syndrome who are hypertensive at baseline are best treated with an ACE inhibitor or an angiotensin receptor blocker and a low-dose thiazide diuretic. —Maria V. Gibson, MD, PhD reduction of 500 to 1000 kcal/d. Several dietary approaches have been advocated. In a study comparing the Mediterranean diet (high in fruits, vegetables, nuts, whole grains, and olive oil) with a low-fat prudent diet, subjects in the Mediterranean diet group had greater weight loss, decreased insulin resistance, and lower levels of markers of inflammation and endothelial function.29 The Dietary Approaches to Stop Hypertension (DASH) diet (daily sodium intake limited to 2400 mg and higher in dairy intake than the Mediterranean diet), when compared with a weightreducing diet, resulted in greater improvements in triglycerides, diastolic BP and fasting glucose, even , after controlling for weight loss.30 Dietary salt reduction to 2 g/d was found to be especially beneficial for African Americans and other ethnic minorities who are disproportionately affected by the metabolic syndrome. Individuals at high risk for type 2 DM should be encouraged to achieve the US Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1000 kcal) and foods containing whole grains (one-half of grain intake). Observational studies suggest a U- or J-shaped association between moderate consumption of alcohol (1-3 drinks [15-45 g alcohol] per day) and decreased risk of type 2 DM, CHD, and stroke. However, heavy consumption of alcohol ( 3 drinks per day) may be associated with an increased incidence of DM. If alcohol is consumed, the amount should be limited to no more than 1 drink per day for women and 2 drinks per day for men.20 Interventions for the prevention of DM and initial treatment of IFG and IGT involve actively encourag- ing weight reduction (7% of body weight) and increased physical activity (150 min/wk). Data from the Finnish Diabetes Prevention Study group, which studied 3234 nondiabetic individuals with IFG and IGT, showed that specific dietary instructions and moderate exercise of more than 30 min/d for a mean duration of 3.2 years reduced the risk of developing diabetes by 58%.31 Exercise is beneficial beyond mere weight loss. Current recommendations call for at least 30 minutes of moderate-intensity exercise every day. However, at least 60 minutes of continuous or intermittent aerobic activity, preferably every day, will promote weight loss or weight-loss maintenance. The Studies of Targeted Risk Reduction Intervention through Defined Exercise Trial has found that duration of exercise is more important than intensity and that the more exercise done, the better the results. More exercise has also been shown to improve lipoprotein concentrations and patterns.32 Pharmacologic approaches Antihypertensives, lipid therapy, and antiglycemic medications are central to the management of many patients with the metabolic syndrome and prediabetes. In addition, patients with the syndrome should generally receive prophylactic aspirin therapy. CV risk reduction includes treatment of hypertension, lowering of serum cholesterol, improvement of glycemic control, and the use of aspirin. Data suggest that patients with the metabolic syndrome who are hypertensive at baseline are best treated with an ACE inhibitor or an angiotensin receptor blocker (ARB) and a low-dose thiazide diuretic. Although the target BP in patients with the metabolic syndrome is unknown, it may be reasonable to aim for levels recommended for patients with type 2 DM ( 130/80 mm Hg). Lipid therapy should follow the ATP III guidelines regarding LDL-C, triglycerides, and HDL-C. The first goal in patients with the metabolic syndrome is to lower LDL-C to the appropriate level prior to targeting the triglyceride and HDL-C abnormalities, except when triglycerides are higher than 16 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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