Treatment of dyslipoproteinemia in the metabolic syndrome

Abstract

The metabolic syndrome consists of a cluster of metabolic disorders, many of which promote the development of atherosclerosis and increase the risk to develop cardiovascular disease. The metabolic syndrome is characterized by atherogenic dyslipidemia (elevated triglycerides, increased small dense low-density lipoproteins, and decreased high-density lipoproteins), hypertension, insulin resistance and obesity. To decrease the risk of cardiovascular disease events decreasing body weight by ingesting a healthy diet, increasing physical activity, cessation of smoking and managing dyslipidemia are recommended. Pharmacological treatment of dyslipidemia is based on different drug classes. For LDL-cholesterol-lowering mainly statins and for triglyceride-lowering mainly fibrates are used. In primary and secondary prevention trials of heart disease they have shown to reduce the incidence of coronary artery disease or coronary events by 25-60 percent. Statins reduce mainly LDL-cholesterol levels by competitive inhibition of HMG-CoA reductase but have also shown to reduce fasting and postprandial triglyceride levels. Fibrates effectively reduce fasting and postprandial lipemia, shift the distribution of LDL particles towards less dense particles and increase HDL-cholesterol. Thus fibrates particularly address components of the metabolic syndrome and features of diabetic dyslipidemia. However studies still are needed showing definite evidence on differential therapy in lipid lowering based on prospective controlled trials with endpoints of macro- and microangiopathy in diabetic patients.

The Effect of Statins on Postprandial Lipemia

“…Statins are the principal agents for managing hyperlipidemia because of their ability to reduce total and LDL cholesterol levels by up to 60% and decrease clinical events [56][57][58]. In contrast to fibrates, statins exert less influence on postprandial lipoprotein metabolism (including large and small CM remnants) [14,[59][60][61][62][63][64][65][66]. However, in an earlier study cerivastatin (which has been withdrawn) was compared with gemfibrozil in terms of their effect on oral fat loadinduced changes in endothelial function and postprandial lipids [67].…”

Metabolic syndrome: A child is not a small adult

“…The clinical definition of insulin resistance, caused by an interrelationship between genetic and environmental influences, is the impaired capacity of insulin to reduce blood glucose (17,18). Despite the mechanism being unclear, we have a significant statistical correlation between hypertension and impaired glucose tolerance and insulin resistance as independent risk factors for coronary heart disease (17,19).…”

Blood Lipids: A Shortcut From Hostility to Chd?

“…The metabolic syndrome consists of a cluster of metabolic disorders, many of them promoting the development of atherosclerosis and increasing the risk of cardiovascular disease events. Elevated serum triglycerides are increasingly seen as valuable clinical markers of the metabolic syndrome (Assmann et al, 1996;Grundy, 1999;Steinmetz et al, 2001;Klimes et al, 2002). With regard to the research literature on the association between hostility and blood lipid levels, several aspects stand out:…”