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Am Fam Physician. 2004;69(4):957

Metabolic syndrome is defined as obesity, insulin resistance, dyslipidemia, and hypertension. Persons who have the syndrome are at increased risk for adverse coronary events and stroke. Aggressive management can decrease mortality. Wong and associates used data from the Third National Health and Nutrition Examination Survey to study the value of improving lipid status and lowering blood pressure on the prevention of coronary heart disease (CHD) events in adults with metabolic syndrome.

They included patients with metabolic syndrome who had greater blood pressure, waist circumference, body mass index, total and low-density lipoprotein (LDL) cholesterol levels, triglycerides, and serum glucose measurements, and lower levels of high-density lipoprotein (HDL) cholesterol. Initial CHD risks of patients with the syndrome were calculated, and then the potential effects of lipid modification and blood pressure reduction to optimal levels (“intervention”) were calculated using known potential prevention statistics.

By calculation, control of blood pressure to normal (120 to 129 mm Hg systolic blood pressure and 80 to 84 mm Hg diastolic blood pressure) would potentially prevent 28.1 percent of CHD events in men and 12.5 percent in women. Control of HDL cholesterol levels to normal (45 mg per dL [1.16 mmol per L] in men and 50 mg per dL [1.30 mmol per L] in women) could prevent approximately one fourth of CHD events. Control of LDL levels to below 130 mg per dL (3.36 mmol per L) resulted in minimal decreased risk, but optimal control to below 100 mg per dL (2.60 mmol per L) provided significantly decreased CHD risk. Modification of all three factors provided between 42 and 80 percent CHD risk reduction. Greater risk reduction was demonstrated among patients at higher risk initially.

The authors conclude that in most patients with metabolic syndrome and poorly controlled lipid profiles and blood pressure, aggressive management significantly reduces CHD risk. This reduction appears more often in patients who are initially at higher absolute risk for a CHD event.

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