Patient Care Endocrinology & Cardiology - October 2007 - (Page 18)

I Metabolic syndrome insulin resistance in patients with PCOS, nonalcoholic steatohepatitis (NASH), and the metabolic syndrome.35 In the Heart Outcomes Prevention Evaluation (HOPE) study, ramipril was shown to prevent development of type 2 DM.36 Aspirin should generally be recommended in all patients with the metabolic syndrome. Virtually all patients with the syndrome who have not yet suffered a clinical CVD event have a 10-year risk of a first event that is far in excess of 10%.37 A recent meta-analysis of 5 primary prevention trials of CVD indicated that aspirin significantly reduces the risk of a first MI by 32% and important vascular events by 15%.37 Based on these randomized data and their meta-analysis, the US Preventive Services Task Force recommended that aspirin be considered for all apparently healthy men and women whose 10year risk of a first CHD event is 6% or greater.38 The AHA has also recommended aspirin for individuals whose 10-year risk of a first CHD is 10% or greater. For low-risk patients whose 10-year risk of a CVD event is less than 10%, the benefits of aspirin are not likely to outweigh the risks of long-term administration.38 21. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136:575-581. 22. Lorenzo C, Okoloise M, Williams K, et al. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003;26:3153-3159. 23. Anand SS, Razak F, Vuksan V, et al. Diagnostic strategies to detect glucose intolerance in a multiethnic population. Diabetes Care. 2003; 26:290-296. 24. Nelson KM, Boyko EJ. Predicting impaired glucose tolerance using common clinical information data from the Third National Health and Nutrition Examination Survey. Diabetes Care. 2003;26:2058-2062. 25. Ninomiya JK, L’Italien G, Criqui MH, et al. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004; 109:42-46. 26. Clark JM, Brancati FL, Diehl AM. Nonalcoholic liver disease. Gastroenterology. 2001;122:1649-1657. 27. Apridonidze T, Essah PA, Iuorno MJ, et al. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90:1929-1935. 28. Ehrmann DA, Liljenquist DR, Kasza K, et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:48-53. 29. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292:1440-1446. 30. Azadbakht L, Mirmiran P, Esmaillzadeh A, et al. Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care. 2005;28:2823-2831. CASE RESOLUTION Our patient was referred to a nutritionist for counseling and was put on a low-fat, 1200 to 1500 kcal/d diet with low salt intake. She was also prescribed moderate-activity exercise for 60 min/d, 5 d/wk. She continued aspirin, 81 mg/d, for CV prevention. The patient was also found to have sleep apnea, and continuous positive airway pressure (CPAP) therapy was recommended. To achieve her BP goal, she was switched from hydrochlorothiazide to ramipril (Altace), 10 mg/d. Three months later, she had lost 2 kg (4.4 lb), her BP was below 130/80 mm Hg, and her lab test results were as follows: fasting blood glucose, 106 mg/dL; LDL-C, 113 mg/dL; triglycerides, 170 mg/dL; and HDL-C, 41 mg/dL. Metformin, 500 mg bid, and nicotinic acid, 250 mg/d, were initiated for treatment of IGT and her elevated triglyceride level, which gradually improved after 6 months of medication and lifestyle modifications. I This article was contributed by Drs Gibson and Hebbar and edited by Peter D’Epiro, PhD. Drs Gibson and Hebbar disclose that they have no financial relationship with any manufacturers in this area of medicine. 31. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343-1350. 32. Kraus WE, Houmand JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002;347: 1483-1492. 33. NCEP Expert Panel on the Detection and Treatment of High Blood Cholesterol in Adults (ATP III). 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) final report. Circulation. 2002;106:3143-3421. 34. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345:1583-1592. 35. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393-403. 36. Eidelman R, Lamas G, Hennekens C. The New National Cholesterol Education Program Guidelines: clinical challenges for more widespread therapy of lipids to treat and prevent coronary heart disease. Arch Intern Med. 2002;162;2033-2038. 37. Eidelman R, Hebert P, Weisman S, Hennekens C. An update on aspirin in the primary prevention of cardiovascular disease. Arch Intern Med. 2003; 163:2006-2010. 38. US Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med. 2003;136:157-160. 18 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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