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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe metabolic syndrome represents a cluster of risk factors (ie, obesity, hypertension, elevated triglycerides, low high-density lipoprotein-cholesterol, and insulin resistance) which lead to an increased risk of heart disease, stroke, and type 2 diabetes. The effects of lifestyle and pharmacologic interventions were discussed during this special session held in collaboration with the World Metabolic Syndrome Project.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic disorder\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EThe metabolic syndrome represents a cluster of risk factors (ie, obesity, hypertension, elevated triglycerides, low HDL-cholesterol, and insulin resistance) which lead to an increased risk of heart disease, stroke, and type 2 diabetes. The effects of lifestyle and pharmacologic interventions were discussed during this special session held in collaboration with the World Metabolic Syndrome Project.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAccording to Jean-Pierre Despr\u00e9s, PhD, Quebec Heart Institute, Canada, intra-abdominal or visceral fat, more than overall weight, plays a significant role in the development of the metabolic syndrome [Despr\u00e9s J-P and Lemieux I. \u003Cem\u003ENature\u003C\/em\u003E 2006]. He reported on the results of a program developed to assess the effect of lifestyle modification in the clinical management of viscerally obese men. Patients (n=185) saw a dietician and an exercise physiologist once per month. After 1 year, there was a significant reduction vs baseline in both subcutaneous (19%) and visceral fat (29%) (both p\u0026lt;0.0001) accompanied by an overall reduction of 7 kg in body weight and an 8.6 cm decrease in waist circumference. Significant improvements were also seen in all of the risk factors associated with the metabolic syndrome (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11233\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11233\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11233\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EChanges in Risk Factor Levels After 1 Year of Diet and Exercise.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EParticularly important was the finding that changes in visceral fat could not be predicted by changes in body weight.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAccording to Dr. Despr\u00e9s, \u201cWe need to go beyond body weight, beyond healthy weight, beyond BMI. We need to increase energy expenditure, which will in turn reduce visceral adipose tissue and lower the risk for cardiovascular disease and diabetes.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPhilip Barter, MD, The Heart Research Institute, Sydney, Australia, discussed pharmacologic interventions in the management of the risk factors associated with the metabolic syndrome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ENumerous studies have proven that statins reduce cardiovascular events (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Statin Trials: LDL-C Levels vs Events.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-736510454\u0022 data-figure-caption=\u0022Statin Trials: LDL-C Levels vs Events.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/5\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11230\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EStatin Trials: LDL-C Levels vs Events.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EDeedwania and colleagues have shown, however, that intensive lowering of LDL-C produced even greater benefit in patients with both coronary heart disease and the metabolic syndrome. Their analysis comprised data from 5,584 patients randomly assigned to receive either atorvastatin 10 mg (n=2,820) or 80 mg per day (n=2,764). Although at a median follow-up of 4.9 years, irrespective of treatment assignment, significantly more patients with metabolic syndrome (11.3%) had a major cardiovascular event than those without metabolic syndrome (8.0%; p\u0026lt;0\u00b70001); the increased risk was significantly reduced by intensive therapy, as shown by significantly fewer events in patients receiving atorvastatin 80 mg (262, 9.5%) vs those receiving the lower dose (367, 13%) (HR 0\u00b771; 95% CI 0\u00b761, 0\u00b784; p\u0026lt;0\u00b70001) [Deedwania P et al. \u003Cem\u003ELancet\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003ESeveral studies that assessed the efficacy of fibrates in the treatment of patients with the metabolic syndrome such as the Helsinki Heart Study [Tenkanen L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1995; Manninen V et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1992], the VA-HIT Study [Rubins HB et al. \u003Cem\u003EArch Int Med\u003C\/em\u003E 2002], and the BIP study [BIP Study Group. \u003Cem\u003ECirculation\u003C\/em\u003E 2000], have shown that the benefits of fibrates were greatest in people with risk factors for the metabolic syndrome such as increased body weight, particularly if associated with low LDL-C, elevated plasma triglycerides, and elevated fasting plasma insulin levels.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EAccording to Dr. Barter, although, theoretically there may be advantages to using statins and fibrates in combination, and studies are underway, this has not been proven. Furthermore, combination of high-dose statins and fibrate (in particular gemfibrozil) has been shown to increase the risk of rhabdomyolysis. Other pharmacologic approaches such as the cannabinoid-1 receptor blockers (rimonabant) are also being investigated but their efficacy in reducing cardiovascular events has not yet been demonstrated.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/5\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm92r\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm92r\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm92r\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}