Established and potential cardiovascular risk factors in metabolic syndrome: Effect of bariatric surgery

AimsHistorically, atherosclerotic cardiovascular disease (ASCVD) risk profile mitigation has had a predominant focus on low density lipoprotein cholesterol (LDL-C). In this narrative review we explore the residual ASCVD risk profile beyond LDL-C with a focus on hypertriglyceridaemia, recent clinical trials of therapeutics targeting hypertriglyceridaemia and novel modalities addressing other residual ASCVD risk factors.FindingsHypertriglyceridaemia remains a significant ASCVD risk despite low LDL-C in statin or proprotein convertase subtilisin/kexin type 9 inhibitor-treated patients. Large population-based observational studies have consistently demonstrated an association between hypertriglyceridaemia with ASCVD. This relationship is complicated by the co-existence of low high-density lipoprotein cholesterol. Despite significantly improving atherogenic dyslipidaemia, the most recent clinical trial outcome has cast doubt on the utility of pharmacologically lowering triglyceride concentrations using fibrates. On the other hand, purified eicosapentaenoic acid (EPA), but not in combination with docosahexaenoic acid (DHA), has produced favourable ASCVD outcomes. The outcome of these trials suggests alternate pathways involved in ASCVD risk modulation. Several other pharmacotherapies have been proposed to address other ASCVD risk factors targeting inflammation, thrombotic and metabolic factors.ImplicationsHypertriglyceridaemia poses a significant residual ASCVD risk in patients already on LDL-C lowering therapy. Results from pharmacologically lowering triglyceride are conflicting. The role of fibrates and combination of EPA and DHA is under question but there is now convincing evidence of ASCVD risk reduction with pure EPA in a subgroup of patients with hypertriglyceridaemia. Clinical guidelines should be updated in line with recent clinical trials evidence. Novel agents targeting non-conventional ASCVD risks need further evaluation.

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Association of Dietary Pattern and Physical Inactivity with Hypertension, Obesity, Diabetes and Metabolic Syndrome

Silva,

Lopes

et al. 2024

Metabolic Syndrome - Lifestyle and Biological Risk Factors

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Physical inactivity and dietary pattern are important cardiovascular risk factors for chronic noncommunicable diseases (CND) and cardiometabolic diseases. To explore details of the association between dietary patterns and physical inactivity with obesity, diabetes, and hypertension, an electronic bibliographic research was conducted in PubMed, Web of Science, Africa Index Medicus, LILACS/SciELO, and African Journal Online Scopus, with descriptors: dietary pattern, physical inactivity, hypertension, diabetes mellitus, overweight/obesity, and metabolic syndrome, with emphasis on studies published in the last 30 years until December 2023. Results are evident, and low physical activity or sedentary is associated with the development of several CND and worsens the situation with consumption of dietary pattern western/unhealthy. However, adherence to a dietary pattern, with greater consumption of salt, refined grains, carbohydrates, has been associated with a high risk of central abdominal obesity and hypertension. The “Westernized” eating pattern is associated with metabolic syndrome, while the Mediterranean eating pattern is considered healthy. Physical inactivity, a sedentary lifestyle, and an unhealthy dietary pattern are the basis for the emergence of overweight/obesity, diabetes mellitus, and hypertension, the main components of metabolic syndrome. The findings can serve as a reference to develop community programs for intervention and health promotion, preventing and managing CND.

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Established and potential cardiovascular risk factors in metabolic syndrome: Effect of bariatric surgery

Cited by 3 publications

References 139 publications

Physical Activity before and After Bariatric Surgery

Physical Activity before and After Bariatric Surgery

Beyond LDL-C: unravelling the residual atherosclerotic cardiovascular disease risk landscape—focus on hypertriglyceridaemia

Association of Dietary Pattern and Physical Inactivity with Hypertension, Obesity, Diabetes and Metabolic Syndrome

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