how is metabolic syndrome treated.docx

7/28/2019 How is metabolic syndrome treated.docx

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How is metabolic syndrome treated?

The major goals are to treat both the underlying cause of the syndrome, andalso to treat the cardiovascular risk factors if they persist. As has been

discussed, the majority of people with metabolic syndrome are overweight

and lead a sedentary lifestyle.

Lifestyle modification is the preferred treatment of metabolic syndrome.

Weight reduction usually requires a specifically tailored multifaceted program

that includes diet and exercise. Sometimes medications may be useful.

Diet

A detailed discussion ofdiet therapies, pros and cons of various diets etc. is

beyond the scope of this article. However, there is now a trend toward the use

of aMediterranean diet-- one that is rich in "good" fats (olive oil) and contains

a reasonable amount of carbohydrates and proteins (such as from fish and

chicken).

The Mediterranean diet is palatable and easily sustained. In addition, recent

studies have shown that when compared to a low fat diet, people on the

Mediterranean diet have a greater decrease in body weight, and also had

greater improvements in blood pressure, cholesterol levels, and other markers

of heart disease -- all of which are important in evaluating and treating

metabolic syndrome.

Exercise

A sustainableexercise program, fore example 30 minutes five days a week is

reasonable to start, providing there is no medical contraindication. (If you

have any special concerns in this regard, check with your doctor first.) There

is a beneficial effect of exercise on blood pressure, cholesterol levels, and

insulin sensitivity, regardless of whetherweight lossis achieved or not. Thus,

exercise in itself is a helpful tool in treating metabolic syndrome.

Cosmetic surgery to remove fat

Some people may ask: Why not just haveliposuctionof the abdomen and

remove the large amount abdominal fat, which is a big part of the problem?

Data thus far shows no benefit in liposuction on insulin sensitivity, blood

pressure, or cholesterol. As the saying goes, "If it's too good to be true, it
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probably is." Diet and exercise are still the preferred primary treatment of

metabolic syndrome.

What if lifestyle changes are not enough to treat metabolic syndrome?

What if changes in lifestyle do not do the trick, what then? Drugs to control

cholesterol levels,lipids, andhigh blood pressuremay be considered.

If someone has already had aheart attack, their LDL ("bad") cholesterol

should be reduced below 100mg/dl. (Some experts now say it should be

under 70mg/dl.) A person who has diabetes has a heart attack risk equivalent

to that of someone who has already one and so should be treated in the same

way. What remains controversial is whether metabolic syndrome should be

considered a coronary equivalent or not. If you have metabolic syndrome, adetailed discussion about lipid therapy is needed between you and your

doctor, as each individual is unique.

Blood pressure goals are generally set lower than 130/80. Some blood

pressure medications offer more than simply lowering blood pressure. For

example, a class of blood pressure drugs calledACE inhibitorshas been

found to also reduce the levels of insulin resistance and actually deter the

development of type 2 diabetes. This is an important consideration when

discussing the choice blood pressure drugs in the metabolic syndrome.

The discovery that a drug prescribed for one condition, and has other

beneficial effects is not new. Drugs used to treathigh blood sugarand insulin

resistance may have beneficial effects on blood pressure and cholesterol

profiles. A class of drugs called thiazolidinediones [pioglitazone (Actos) and

rosiglitazone(Avandia)] also reduce the thickness of the walls of the carotid

arteries.

Metformin(Glucophage), usually used to treat type 2 diabetes, also has beenfound to help prevent the onset of diabetes in people with metabolicsyndrome. Indeed, in my practice, I routinely discuss metformin with mypatients who have metabolic syndrome. Many of my patients who have insulinresistance associated with metabolic syndrome opt for metformin therapy.However, there are currently no established guidelines on treating metabolicsyndrome patients with metformin if they do not have overt diabetes.

How Is Metabolic Syndrome Treated?

Healthy lifestyle changes are the first line of treatment for metabolic
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syndrome. Lifestyle changes include losing weight, doing physical activity

regularly, following a heart healthy diet, and quitting smoking.

If lifestyle changes aren't enough, your doctor may prescribe medicines.

Medicines are used to treat and control risk factors such ashigh blood

pressure, high triglycerides, low HDL cholesterol, and high blood sugar.

Blood-thinning medicines, such as aspirin, also may be used to reduce the

risk of blood clots.Excessive blood clottingis a condition that often occurs

with metabolic syndrome.

Goals of Treatment

The major goal of treating metabolic syndrome is to reduce the risk ofheart

disease. Treatment is directed first at lowering LDL cholesterol and high blood

pressure and managing diabetes (if these conditions are present).

The second goal of treatment is to prevent the onset of type 2 diabetes (if it

hasn't already developed). Long-term complications of diabetes often include

heart and kidney disease, vision loss, and foot or leg amputation.

If diabetes is present, the goal of treatment is to reduce the increased risk of

heart disease by controlling all of your risk factors.

The main focus of treating metabolic syndrome is managing the risk factors

that are within your control, such asoverweight or obesity, an inactive

lifestyle, and an unhealthy diet.

Lifestyle Changes

Losing Weight

In general, people who have metabolic syndrome and are overweight or

obese should try to reduce their weight by 710 percent during the first year of

treatment. For example, if you weigh 250 pounds, you should try to lose 18 to

25 pounds. If you weigh 300 pounds, you should try to lose 21 to 30 pounds.

After the first year, you're urged to continue to lose weight to the extent

possible, with a long-range target of lowering your body mass index (BMI) to

less than 25. BMI measures your weight in relation to your height and gives

an estimate of your total body fat.

A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is

considered obese. A BMI of less than 25 is the goal for prevention and

treatment of metabolic syndrome.

You can calculate your BMI using the National Heart, Lung, and Blood
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Institute's (NHLBI's)online calculator, or your health care provider can

calculate your BMI.

For more information on losing weight or maintaining your weight, see the

Diseases and Conditions Index article onOverweight and Obesity.

Following a Heart Healthy Diet

A heart healthy diet is an important part of a healthy lifestyle. Choose a variety

of fruits, vegetables, and grains; half of your grains should come from whole-

grain products.

Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy

choices include lean meats, poultry without skin, fish, beans, and fat-free or

low-fat milk and milk products.

Try to limit foods that have a lot of sodium (salt). Too much salt can raise your

risk ofhigh blood pressure. Recent studies show that following the Dietary

Approaches to Stop Hypertension (DASH) eating plan can lower blood

pressure.

Choose foods and beverages that are low in added sugar. If you drink

alcoholic beverages, do so in moderation.

Aim for a healthy weight by staying within your daily calorie needs. Balance

the calories you take in with the calories you use while doing physical activity.

For more information on following a heart healthy diet, see the NHLBI'sAim

for a Healthy WeightWeb site,"Your Guide to a Healthy Heart,""Your Guide

to Lowering Your Blood Pressure With DASH,"and"Your Guide to Lowering

Your Cholesterol With TLC."All of these resources provide general

information about healthy eating.

Doing Physical Activity Regularly

Being physically active, along with following a healthy diet and not smoking, is

one of the most important things you can do to keep your heart and lungs

healthy.

Many Americans are not active enough. The good news is that even modest

amounts of physical activity are good for your health. The more active you

are, the more you'll benefit.

Before starting any kind of exercise program or new physical activity, talk with

your doctor about the types and amounts of physical activity that are safe foryou.
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The four main types of physical activity are aerobic, muscle-strengthening,

bone strengthening, and stretching. You can do physical activity with light,

moderate, or vigorous intensity.

The level of intensity depends on how hard you have to work to do the

activity. People who have metabolic syndrome usually are urged to keep up a

moderate level of activity.

For more information about physical activity, see the U.S. Department of

Health and Human Services"2008 Physical Activity Guidelines for

Americans,"the Diseases and Conditions IndexPhysical Activity and Your

Heartarticle, and the NHLBI's"Your Guide to Physical Activity and Your

Heart."

Smoking

If you smoke, quit. Smoking can raise your risk of heart disease andheart

attackand worsen other heart disease risk factors. Talk to your doctor about

programs and products that can help you quit smoking. Also, try to avoid

secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support

group. Many hospitals, workplaces, and community groups offer classes to

help people quit smoking.

Medicines

If lifestyle changes aren't enough, your doctor may prescribe medicines to

help you control your risk factors. Medicines may be prescribed to help treat

unhealthy cholesterol levels, high blood pressure, and high blood sugar.

Unhealthy cholesterol levels are treated with medicines such as statins,

fibrates, or nicotinic acid. High blood pressure is treated with medicines such

as diuretics or ACE inhibitors. High blood sugar is treated with oral medicines

(such as metformin), insulin injections, or both.

Low-dose aspirin can help reduce the risk of blood clots, especially for peopleat high risk of heart disease.
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