Abstract
The metabolic syndrome, one of the most important public health problems in XXI century for its associations with cardiovascular diseases; is constituted by an assembly of alterations as: abdominal obesity, aterogenic dislipidemia, arterial hypertension, hyperglycaemia, and a protrombotic and inflammatory state.
The International Diabetes Federation proposed a new definition where the abdominal obesity, determined by the perimeter of the waist is the main parameter. This cheap and simple measurement changes according to the ethnic groups.
This paper review the natural history of diabetes mellitus type 2, the abdominal obesity as cardiovascular risk factor and its association with others risk factors; and also review some actions for the early detection of metabolic syndrome.
Finally, it described the current diagnostic and treatment of patients with metabolic syndrome and the utility of the new medications for the management of the multiple risk factors presents in those patients
References
Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415-28.
Zimmet P, Alberti GMM, Serrano M. Una nueva definición mundial del síndrome metabólico propuesta por la Federación Internacional de Diabetes: fundamento y resultados. Rev Esp Cardiol 2005; 58(12): 1371-6.
Grundy SM. Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worldas. J Am Coll Cardiol 2006; 47: 1093 -100.
Sierra ID, Mendivil CO. Hacia el manejo práctico de la diabetes mellitus tipo 2. 2da edición. Bogotá: Editorial Kimpres LTDA; 2004.p. 3 - 218.
Grundy S, Cleeman J, Daniels SR, Donato KA, Eckel RH, Franklin, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association
/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 1- 18.
Lastra G, Manrique C, Lastra G. Síndrome cardiometabólico. Inflamación, tejido adiposo, resistencia a la insulina y aterogénesis - se expande el rompecabezas. Acta Med Colomb 2005; 30: 100 - 111.
Bays H, Mandarino L, Defronzo R. Role of the adipocyte, free fatty acids, and ectopic fat in pathogenesis of type 2 diabetes mellitus: peroxisomal proliferator - activated receptor agonists provide a rational therapeutic approach. J Clin Endocrinol Metab 2004; 89 (2): 463 -478.
Carey VJ, Walters EE, Colditz GA et al. Body fat distribution and risk of non- insulin dependent diabetes mellitus in women. The Nurses`Health Study. Am J Epidemiol 1997; 145: 614 -9.
Han TS, Williams K, Sattar N, Hunt KJ, Lean ME, Haffner SM. Analysis of obesity and hiperinsulinemia in the development of metabolic syndrome: San Antonio Heart Study. Obes Res 2002; 10: 923 - 31.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (The INTERHEART Study): case - control study. Lancet 2004; 364 - 937 - 52.
Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford, et al. Obesity and the risk of myocardial infarction in 27000 participants from 52 countries : a case -control study. Lancet 2005; 366: 1640-1649.
Stern MP, Williams K, Gonzalez Villalpando C, Hunt K, Haffner SM. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and / or cardiovascular disease? Diabetes care 2004; 27: 2676 -81.
Lam TK, Carpentier A, Lewis GF et al. Mechanisms of the free fatty acid - induced increase in hepatic glucose production. Am J Physiol Endocrinol Metab 2003; 284: E 863 - 73.
Carr MC, Brunzell JD. Abdominal obesity and dislipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk. J Clin Endocrinol Metab 2004; 89: 2601 - 7.
Pouliot MC, Despres JP, Nadeau A, et al. Visceral obesity in men. Associations with glucose tolerance, plasma insulin and lipoprotein levels. Diabetes 1992; 41: 826 -34.
Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care 2004; 27: 813- 823.
Marette A. Mediators of cytokine - induced insulin resistance in obesity and other inflammatory settings. Curr Opin Clin Nut Metab Care 2002; 5: 377- 83.
Stumvoll M, Goldstein B, W van Haeften T. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005; 365: 1333 - 46.
American Diabetes Association, National Institute of Diabetes, Digestive and Kidney Diseases. Prevention or Delay of Type 2 Diabetes. Diabetes Care 2004; 27: S47 - S 54.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne - Parikka P, Keinanen - Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa
M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343 - 1350.
Diabetes Prevention Research Group. Reduction in the evidence of type 2 diabetes with life - style intervention or metformina. N Engl J Med 2002; 346: 393 - 403.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M, for the STOP - NIDDM Trial Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP - NIDDM randomized trial. Lancet 2002; 359: 2072-2077.
Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic B -cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high - risk Hispanic women. Diabetes 2002; 51: 2796 - 2803.
Togerson J, Hauptman J, Boldrin MN et al. A randomized study of Orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155 - 161.
Abuissa H, Jones PG, Marso SP, O´Keefe JH. Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers for Prevention of Type 2 Diabetes. A meta- analysis of randomized clinical trials. J Am Coll Cardiol 2005; 46:821-6.
Kothari V, Stevens RJ, Adler AI, et al. UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK Prospective Diabetes Study risk engine. Stroke 2002; 33:1776-81.
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348:383-93.
Heart Protection Study Collaborative Group, MRC/BHF Heart Protection Study of cholesterol - lowering with simvastatin in 5963 people with diabetes: a randomised placebo - controlled trial. Lancet 2003; 361: 2005 -16.
Goldberg RB, Mellies MJ, Sacks FM et al. For the CARE investigators. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant, myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol and Recurrent Events (CARE) trial. Circulation 1998; 98:2513 -9.
Robins SJ, Rubins HB, Faas FH et al. Insulin resistance and cardiovascular events with low HDL cholesterol. The Veterans Affairs HDL Intervention Trial (VA-HIT). Diabetes Care 2003; 26(5): 1513-7.
National Cholesterol Education Program (NCEP) Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel 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.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL jr, Jones DW, Materson BJ, Oparil S, WrightJT Jr, Roccella EJ. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh Report of he Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood pressure: the JNC 7 report. JAMA 3003; 289:2560-2572.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2005; 38: S4-S36.
Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr, Smith SC Jr, Stone NJ, Taubert KA. AHA Guidelines for Primary Prevention of Cardiovascular disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients without Coronary or other Atherosclerotic Vascular Diseases. American Heart association science Advisory and Coordinating Committee. Circulation 2002; 106: 388-391.
Ridker PM, Wilson PW, Grundy SM. Should C- reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004; 109: 2818-2825.
Di Marzo V, Bifulco M, De Petrocellis L. The endocannabinoid system and its therapeutic exploitation. Nat Rev Drug Discov 2004; 3:771-84.
Després JP, Golay A, Sjostrom L, for the Rimonabant in Obesity - Lipids Study Group (RIO - Lipids). Effects of Rimonabant on Metabolic Risk Factors in Overweight Patients with Dyslipidemia. N Engl J Med 2005; 353:2121
-34.
Pi-Sunyer X, Aronneb LJ, Heshmati HM, Rosenstock J, for the RIO -North America Study Group. Effect of Rimonabant, a Cannabinoid -1 Receptor Blocker, on weight and cardiometabolic risk factors in overweight or obese patients, RIO- North America: A randomized controlled trial. JAMA 2006; 295:761-775.
Van Gaal LF, Rissanen AM, Scheen AJ, Ziegler O, Rossner S, for the RIO- Europe Study Group. Effects of the cannabinoid - 1 receptor blocker Rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1- year experience from the RIO - Europe study. Lancet 2005; 365: 1389 - 1397.
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