The effectiveness of the treatment of metabolic syndrome in coronary heart disease

The effectiveness of the treatment of metabolic syndrome in coronary heart disease

Risk associated with metabolic syndrome. Metabolic syndrome is a cluster of metabolic disorders, which includes insulin resistance (IR), dyslipidemia (DLP), arterial hypertension (AH), proinflammatory state and overweight (MT), especially abdominal obesity.

The prevalence of the syndrome in the United States: 27% of adults and 10% of adolescents aged 12-19 years meet the criteria for metabolic syndrome (MS). Persons with MS have an increased risk of death from cardiovascular disease (CVD). Not all patients with metabolic syndrome (MS) have the same risk of developing type 2 diabetes mellitus (DM-2) or vascular events; results from several studies suggest that there are other factors, such as inflammation, that can determine high-risk subgroups.

The benefits of treating metabolic syndrome (MS). Two randomized clinical studies have shown that lifestyle changes are of considerable benefit to patients with metabolic syndrome (MS) or impaired glucose tolerance (IGT). In the Finnish Diabetes Prevention Study 522 people. overweight (MT) and impaired glucose tolerance (IGT) did not undergo any intervention or received individual advice regarding weight loss, total fat intake and increase in physical activity (FA).

After 3.2 years of follow-up, the reduction in body weight (MT) was significantly more pronounced in the active intervention group, the incidence of diabetes-2 decreased from 23 to 11%, and the risk decreased by 60% (p <0.001). With such a simple intervention, treatment for 5 years, 5 patients with impaired glucose tolerance (IGT) will prevent 1 case of DM-2.

Further support for this hypothesis was obtained in the course of the Diabetes Prevention Program, in which 3234 patients without diabetes but with impaired glucose metabolism were randomly divided into a group on lifestyle changes aimed at reducing MT and increasing FA, metformin group or placebo. In this study, the implementation of a lifestyle change program resulted in a 58% reduction in diabetes-2 cases compared with the placebo group, while metformin reduced the risk by 31%. It is important that lifestyle changes led to a significantly greater risk reduction than drug therapy.

These two studies have shown that diabetes mellitus-2 can be prevented or delayed, which in turn will reduce atherosclerotic complications in this high-risk group.

However, accurate estimates of reductions in cardiovascular events (SSSob) are not known, therefore cost-effectiveness ratio data are not available.

Interventions related to lifestyle modification can have a large impact on a population. In a prospective study of women, diabetes developed in> 90% of cases of those who did not exercise, had a BMI> 25 kg / m2 and had poor dietary habits, and also smoked.

The effect of exercise should not be underestimated, because in 30% of patients with diabetes, minimal FN was noted during their lifetime. Moreover, although the determination of glycemia 2 hours after FN has the best sensitivity in assessing the risk in patients without diabetes compared to determining fasting glucose, the clinical benefit of this approach remains very modest.

Recommendations. ATP III and JNC-7 guidelines relate to metabolic syndrome (MS). Patients are classified as having metabolic syndrome (MS) in the presence of> 3 of the following symptoms: • waist size> 102 cm in men and> 88 cm in women; • Blood pressure> 135/85 mm Hg. v .; • cholesterol cholesterol level <40 mg / dL for men and <50 mg / dL for women; • TG level> 150 mg / dL; • fasting glucose level> 100 mg / dL.

The main goal of therapy is the underlying insulin resistance (IR). The most safe and effective strategy to reduce insulin resistance (IR) is to reduce body weight (MT) and increase physical activity (FA). Although drugs have been developed that can improve IR, there is no clear evidence that they reduce the risk of CHD in patients with MS. Drug therapy aimed at improving the lipid profile, lowering blood pressure and treating a prothrombotic state reduces cardiac risk in this population.

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