Metabolic Syndrome and Cardiovascular Disease -3

To reduce the burden of metabolic syndrome in society, obesity prevention deserves a high priority for public health. This is true for all nations of the world.
Changing lifestyles can largely account for the rising prevalence of the syndrome throughout the world. For much of the world, life is becoming more sedentary and food is increasingly available. Both lead to energy overload and obesity.

Society is ill prepared to reverse this trend. But both governments and society at large must recognize the consequences of allowing obesity to develop unchecked.
Greater national commitments to modifying the structure of daily life habits will be required to reverse this unfortunate trend.

For individuals who have developed obesity, management requires intervention by the healthcare community. Priority in clinical management should go to persons in whom obesity has elicited the metabolic syndrome. A major challenge to the healthcare system is to develop more efficient lifestyle interventions.

This may require creation of clinical management structures that do not currently exist in most medical settings. In overweight/obese subjects with the metabolic syndrome, the primary goal is to reduce body weight by 10% in the first year. If this can be achieved, a secondary goal is to reduce weight to the desirable range, e.g., a body mass index less than 25 kg/m 2 . To achieve these goals, a combination of caloric restriction, behavior modification, and increased physical activity will be required.

The second aim in management of the metabolic syndrome is to reduce metabolic susceptibility. The most practical means for achieving this aim is to enhance physical activity. Regular exercise will lower insulin resistance, improve cardiovascular risk factors overall, and reduce risk for cardiovascular events through multiple mechanisms. Further any secondary causes of metabolic susceptibility should be appropriately treated. Drug treatment of metabolic susceptibility is problematic. However, insulin sensitizers are promising. Included in this list are metformin and thiazolidinediones. The pharmaceutical industry is engaged in intensive research to develop new agents for reducing susceptibility to the metabolic syndrome; but at present, this field of research is in its infancy.

The third therapeutic approach is to favorably modify each of the risk-factor components of the syndrome with drug therapies. It is appropriate to use absolute risk estimates to guide choice and intensity of drug therapy. Several risk-assessment tools are available for estimating absolute risk. Among these are Framingham and PROCAM risk scoring. Others are under development.

Eventually, population-based risk scoring will be available so that absolute risk can be estimated from equations that factor in the baseline risk of the population.

Some investigators have attempted to estimate absolute risk from the components of the metabolic syndrome alone. This is a mistake. The components of the syndrome do not incorporate all of the contributions to global cardiovascular risk.