Management of Dyslipidemia in the Metabolic Syndrome
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- 作者：Juan Ascaso (1)
Pedro Gonzalez Santos (2)
Antonio Hernandez Mijares (3)
Alipio Mangas Rojas (4)
Luis Masana (5)
Professor Jesus Millan (6)
Luis Felipe Pallardo (7)
Juan Pedro-Botet (8)
Francisco Perez Jimenez (9)
Xavier Pintó (10)
Ignacio Plaza (11)
Juan Rubiés (12)
Manuel Zú?iga (13) - 刊名：American Journal of Cardiovascular Drugs
- 出版年：2007
- 出版时间：January 2007
- 年：2007
- 卷：7
- 期：1
- 页码：39-58
- 全文大小：201 KB
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Pedro Gonzalez Santos (2)
Antonio Hernandez Mijares (3)
Alipio Mangas Rojas (4)
Luis Masana (5)
Professor Jesus Millan (6)
Luis Felipe Pallardo (7)
Juan Pedro-Botet (8)
Francisco Perez Jimenez (9)
Xavier Pintó (10)
Ignacio Plaza (11)
Juan Rubiés (12)
Manuel Zú?iga (13)
1. Endocrinolgy Service, Clinic University Hospital, University of Valencia, Valencia, Spain
2. Department of Internal Medicine, University Hospital “Virgen de la Victoria- University of Malaga, Malaga, Spain
3. Endocrinology Service, University Hospital “Peset- University of Valencia, Valencia, Spain
4. Internal Medicine Service, University Hospital “Puerta del Mar- University of Cadiz, Cadiz, Spain
5. Department of Medicine, University of Reus, Tarragona, Spain
6. Department of Medicine, University Hospital “Gregorio Mara?ón- University Complutense, c/ Dr Esquerdo 46, Madrid, 28007, Spain
7. Endocrinology and Nutrition Service, University Hospital “La Paz- Autonomous University of Madrid, Madrid, Spain
8. Department of Internal Medicine, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
9. Lipid and Atherosclerosis Unit, Internal Medicine Service, University Hospital “Reina Sofía- University of Córdoba, Córdoba, Spain
10. Lipid and Atherosclerosis Unit, Internal Medicine Service, University Hospital of Bellvitge, Barcelona, Spain
11. Cardiology Service, Hospital Ramón y Cajal, Madrid, Spain
12. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
13. Department of Internal Medicine, University Hospital “Marqués de Valdecilla- Santander, Spain
文摘
In order to characterize the metabolic syndrome it becomes necessary to establish a number of diagnostic criteria. Because of its impact on cardiovascular morbidity/mortality, considerable attention has been focussed on the dyslipidemia accompanying the metabolic syndrome. The aim of this review is to highlight the fundamental aspects of the pathophysiology, diagnosis, and the treatment of the metabolic syndrome dyslipidemia with recommendations to clinicians. The clinical expression of the metabolic syndrome dyslipidemia is characterized by hypertriglyceridemia and low levels of high-density lipoprotein-cholesterol (HDL-C). In addition, metabolic syndrome dyslipidemia is associated with high levels of apolipoprotein (apo) B-100-rich particles of a particularly atherogenic phenotype (small dense low-density lipoprotein-cholesterol [LDL-C]. High levels of triglyceride-rich particles (very low-density lipoprotein) are also evident both at baseline and in overload situations (postprandial hyperlipidemia). Overall, the ‘quantitative-dyslipidemia characterized by hypertriglyceridemia and low levels of HDL-C and the ‘qualitative-dyslipidemia characterized by high levels of apo B-100- and triglyceride-rich particles, together with insulin resistance, constitute an atherogenic triad in patients with the metabolic syndrome. The therapeutic management of the metabolic syndrome, regardless of the control of the bodyweight, BP, hyperglycemia or overt diabetes mellitus, aims at maintaining optimum plasma lipid levels. Therapeutic goals are similar to those for high-risk situations because of the coexistence of multiple risk factors. The primary goal in treatment should be achieving an LDL-C level of <100 mg/dL (or <70 mg/dL in cases with established ischemic heart disease or risk equivalents). A further goal is increasing the HDL-C level to ?0 mg/dL in men or 50 mg/dL in women. A non-HDL-C goal of 130 mg/dL should also be aimed at in cases of hypertriglyceridemia. Lifestyle interventions, such as maintaining an adequate diet, and a physical activity program, constitute an essential part of management. Nevertheless, when pharmacologic therapy becomes necessary, fibrates and HMG-CoA reductase inhibitors (statins) are the most effective drugs in controlling the metabolic syndrome hyperlipidemia, and are thus the drugs of first choice. Fibrates are effective in lowering triglycerides and increasing HDL-C levels, the two most frequent abnormalities associated with the metabolic syndrome, and statins are effective in lowering LDL-C levels, even though hypercholesterolemia occurs less frequently. In addition, the combination of fibrates and statins is highly effective in controlling abnormalities of the lipid profile in patients with the metabolic syndrome.