engleski

Metabolic Syndrome Management – a multifaceted therapeutic approach

The metabolic syndrome refers to the clustering of cardiovascular risk factors that include diabetes, obesity, dyslipidemia and hypertension. Insulin resistance and visceral obesity have been recognized as the most important pathogenic factors. Metabolic abnormalities result from the interaction between the effects of insulin resistance primarily in muscle and adipose tissue and the adverse impact of the hyperinsulinemia on tissues that remain normally insulin sensitive. The clinical heterogeneity of the syndrome can be explained by its significant role on glucose, fat and protein metabolism, cellular growth and differentiation and endothelial function. Whatever the uncertainties of definition and etiology, metabolic syndrome represents a useful and simple clinical concept which allows earlier detection of type2 diabetes and cardiovascular disease. The large number of underlying cardiovascular risk factors calls for a multifaceted therapeutic approach. If the risk factors are not sufficiently modified despite lifestyle interventions, which represent the fundamental strategy, the selective use of proven drug therapies is required. Insulin sensitizers metformin or pioglitazone should be added to the treatment regimen for the management of diabetes. Incretin based therapy might be preferred as their clinical benefits extend beyond that of lowering glucose level. The addition of a lipid-modifying agent is also necessary if dyslipidemia is not controlled by lifestyle changes. To correct the typical atherogenic dyslipidemia of the metabolic syndrome co- administration of a statin with a fibrate is often needed. Between antihypertensive agents, a particular emphasis should be placed on the RAAS blockade and central sympatholytic agents which exert additional beneficial metabolic effects.

metabolic syndrome; insulin resistance; therapeutic approach

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