18. Treatments for the Metabolic Syndrome

  1. Christopher D. Byrne FRCP, FRCPath, PhD3 and
  2. Sarah H. Wild FRCPE, FFPH, PhD4
  1. Markolf Hanefeld MD, PhD1,
  2. Ulrike Schatz MD2 and
  3. Frank Schaper MD1

Published Online: 10 JUN 2011

DOI: 10.1002/9781444347319.ch18

The Metabolic Syndrome, Second Edition

The Metabolic Syndrome, Second Edition

How to Cite

Hanefeld, M., Schatz, U. and Schaper, F. (2011) Treatments for the Metabolic Syndrome, in The Metabolic Syndrome, Second Edition (eds C. D. Byrne and S. H. Wild), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444347319.ch18

Editor Information

  1. 3

    Institute for Developmental Sciences, Southampton General Hospital, Southampton, UK

  2. 4

    Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK

Author Information

  1. 1

    Centre for Clinical Studies, Technical University Dresden, Dresden, Germany

  2. 2

    University Hospital Dresden, Dresden, Germany

Publication History

  1. Published Online: 10 JUN 2011
  2. Published Print: 12 AUG 2011

ISBN Information

Print ISBN: 9781444336580

Online ISBN: 9781444347319

SEARCH

Keywords:

  • metabolic syndrome;
  • dyslipidemia;
  • prediabetes;
  • hypertension;
  • inflammation;
  • lifestyle;
  • medical treatment;
  • polypharmacy

Summary

The metabolic syndrome represents a high risk group for coronary heart disease as well as for type 2 diabetes. Treatment so far is mainly directed to individualized needs of single traits such as hypertension, dyslipidemia and type 2 diabetes. Usually the cut-off limits of the ATP-III classification were used as targets. The rational of the concept of the metabolic syndrome requires an integrated approach for a treatment of this cluster of diseases and its complications. Insulin resistance and visceral obesity are major components of the common soil for the metabolic syndrome and atherosclerotic vascular disease (AVD). Therefore lifestyle intervention with reduction of overweight, low fat diet rich in complex carbohydrates and physical endurance exercise are the primary options which form a basic treatment for all diseases of the metabolic syndrome. It is estimated that more than 50% of the diseases of the metabolic syndrome may be treated by intensified lifestyle and behavior modification only. The “Ornish program” is an example for successful lifestyle intervention.

Medical treatment of traits of the metabolic syndrome should be scrutinized with respect to pleiotropic effects on insulin resistance, adipokines and low-grade inflammation as components of the common soil for diseases of the metabolic syndrome and AVD. Vice versa adverse effects of drugs on common soil and comorbidities should be considered. In the treatment of obesity orlistat as well as sibutramin have additional beneficial effects on dysglycemia and dyslipidemia. In the treatment of prediabetes and of type 2 diabetes anti-hyperglycemic agents such as metformin and acarbose have also therapeutic effects on overweight, dyslipidemia and blood pressure, the latter only by acarbose. Metformin and acarbose were also effective in prevention of AVD. The glitazones have a broad spectrum of pleiotropic effects on dyslipidemia, inflammation and hypertension. In medical treatment of dyslipidemia statins, fibrates and also nicotinic acid have proven effects on low grade inflammation, but statins and nicotinic acid may deteriorate glucose tolerance. All lipid lowering drugs should prevent vascular complications.

In treatment of hypertension ACE inhibitors and angiotension receptor 1 blockers have shown a tendency to reduce the incidence of newly diagnosed diabetes. Beta blockers and diuretics, particularly in combination increase the risk of diabetes and deteriorate dyslipidemia and glucose control in type 2 diabetes.

So far no polypill is available to reduce the burden of polypharmacy for the patients. However some fixed combinations with synergistic effects on the metabolic syndrome may reduce the number of pills.

In conclusion an integrated approach in the treatment of the metabolic syndrome is needed with lifestyle intervention as the first option.