Given the markedly increased risk of developing DM and CV events, early recognition of metabolic abnormalities and efforts at primary prevention are of paramount importance. Lifestyle modifications remain the cornerstone of therapy and should be combined with aggressive pharmacologic control of metabolic factors when warranted. A multifactorial intervention involving lifestyle modifications and aggressive pharmacologic therapy in high-risk diabetic patients with microalbuminuria was associated with a 50% lower risk of CVD compared with conventional treatment of modifiable risk factors. An aggressive approach appears to be similarly warranted in high-risk MS subjects.
Weight loss, dietary modification, and exercise are the cornerstones of lifestyle interventions in MS. Weight loss through diet and exercise, but not liposuction, reduces inflammatory markers in obese patients. Modest weight loss and regular exercise reduces the risk of developing DM by 50%, which is better than the results achieved with medication, in high-risk patients with glucose abnormalities. Alpha glucosidase inhibitors, TZDs, and orlistat also appear to retard the development of DM in high-risk subjects, which may result in improved CV outcomes. Bariatric surgery can also markedly improve glucose metabolism in obese subjects and may be appropriate in selected subjects.
MS is associated with an increased risk of CV above and beyond the contribution of its individual metabolic components. Visceral adiposity and associated insulin resistance are associated with a pro-inflammatory and pro-thrombotic state, as well as the release of adipokines, which may both directly and indirectly influence atherogenesis. Hypertension and hyperlipidemia in the presence of MS greatly enhances CV risk. MS is also associated with a marked increase risk in the development of DM, especially in the presence of impaired glucose metabolism.The development of DM while on treatment for hypertension appears to portend an increased risk of CV events comparable with subjects with hypertension and established DM. Identification of metabolic risk factors and aggressive lifestyle interventions are warranted in all patients, with aggressive pharmacologic intervention when appropriate. Ôûá