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A search of PubMed was conducted for specific references. Guidlelines
for reference were obtained from www.guideline.gov. UptoDate was
queried for general content.
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The term metabolic syndrome refers to a constellation of interrelated
conditions that directly promote the development of atherosclerotic
cardiovascular disease (CVD) and type 2 diabetes mellitus. The term
metabolic syndrome has become widely accepted in the medical literature.
The primary care provider is faced with the implications of the
diagnosis of the metabolic syndrome for patients. Identification
of one risk component of the metabolic syndrome should prompt evaluation
of other components.1 Early identification of the cluster
of risks of CVD and diabetes may be important in educating patients
on lifestyle interventions to avert or delay the development of
CVD and type 2 diabetes. Pharmacologic treatment for metabolic syndrome
does not differ from the treatment for the traditional risks for
CVD including diabetes, hypertension, and hyperlipidemia, although
more research on prevention and treatment of metabolic syndrome
is clearly needed.
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In 1988, Reaven first described a cluster of risk factors associated
with CVD, which included hyperglycemia, low high-density lipoprotein,
hypertriglyceridemia, and hypertension. He coined the phrase “syndrome
X” and proposed that the pathophysiology leading to CVD
is related to insulin resistance resulting in hyperinsulinemia.
Reaven recognized an association with obesity and syndrome X but
did not consider obesity a central component of syndrome X.2
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Since Reaven’s landmark presentation, other names have
been applied to the syndrome including metabolic syndrome X, dysmetabolic
syndrome, plurimetabolic syndrome, and the insulin resistance syndrome.
Failure to reach consensus on a universally acceptable title stems
from the fact that the exact causes of metabolic syndrome remain
elusive. Strictly speaking, this is an association of conditions,
not a syndrome3, however, the term gained popularity during
the last few years. Extensive research in the areas of epidemiology,
pathophysiology, and clinical care related to metabolic syndrome
has been done.
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Multiple methods have been used during the last 10 years to define
the metabolic syndrome criteria. The World Health Organization proposed
diagnostic criteria of metabolic syndrome in 1998.4 These
guidelines were not widely accepted, as there is a requirement for
evaluation of insulin resistance either by oral glucose tolerance
test or euglycemic clamp. Both methods are difficult to conduct
in the clinical setting. The National Cholesterol Education Program
(NCEP) Adult Treatment Panel III (ATP III) proposed a set of criteria
in 2001 based on common clinical measures including waist circumference,
triglycerides (TG), HDL cholesterol, blood pressure (BP), and fasting
glucose level. Abnormal findings in 3 of the 5 areas constitute
a positive diagnosis.1 Modifications to these criteria
have been suggested by several organizations since 2001, including
the American Heart Association (AHA), the National Heart, Lung,
and Blood Institute,5 and the International Diabetes Foundation
(IDF).6Table 26-1 lists the diagnostic criteria for the
modified ATP III guidelines as suggested by the AHA and National
Heart, ...