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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\u003EThis article describes the six risk conditions associated with the metabolic syndrome, and their appropriate interventions, including: abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance\/glucose intolerance, proinflammatory states, and prothrombotic states.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERoger S. Blumenthal, MD, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, described the six risk conditions associated with the metabolic syndrome, and their appropriate interventions:\u003C\/p\u003E\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\/10993\/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\/10993\/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\/10993\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\u003C\/div\u003E\u003Cp id=\u0022p-3\u0022\u003EIntensive lifestyle changes can reduce the progression to diabetes by nearly 60%, Dr. Blumenthal noted, largely through robust dietary interventions and a regular exercise program of 30 minutes of moderate activity per day\u2014or \u201c10,000 steps.\u201d \u201cThese actions are just as important as giving aspirin or a cholesterol-lowering pill every day,\u201d he remarked.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EGail Underbakke, MS, RD, of the University of Wisconsin, Madison, noted that diet has an effect on endothelial function. Fruits, vegetables, folic acid, and omega-3 fatty acids improve vascular function, while high-fat diets (especially saturated and trans fats) worsen postprandial vascular function. Studies with antioxidant vitamins show mixed results, she said.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the optimal diet, calories should be appropriate for weight management. Carbohydrates should be \u0026lt;60% of calories (high fiber, limit concentrated sugars), fat should be 25% to 35% of calories (emphasize monounsaturated fat, omega-3 from fish and plants, and 1 ounce of nuts per day), protein should be 15% to 20% of calories (from low-saturated fat sources and plant proteins), vegetables and fruits should be consumed in abundance, and processed foods should be minimized.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ESteven M. Haffner, MD, University of Texas Health Science Center, San Antonio, posed three \u201ckey questions\u201d regarding the metabolic syndrome: 1) Does the presence of impaired fasting glucose suggest the need for intensification of cardiovascular risk factor management? 2) Is pharmacologic treatment of impaired fasting glucose and\/or impaired glucose tolerance justified to prevent or delay type 2 diabetes? 3) Does therapy for prevention or delay of diabetes decrease cardiovascular disease?\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EUnfortunately, the answers to these questions, at this point, are \u201cambiguous,\u201d he said. The increase in coronary heart disease risk is \u201cmodest\u201d in the setting of impaired fasting glucose, therefore, intensification of risk factor management in this population is not formally recommended. Treatment for impaired fasting glucose or impaired glucose tolerance is only recommended in very-high-risk subjects who have more than a 10% per year risk of developing diabetes. Finally, there is little evidence that preventing diabetes will also prevent cardiovascular disease.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EFurthermore, added Lynda Powell, PhD, of Rush University Medical Center, Chicago, it is difficult to motivate patients to make even those changes that clearly prevent cardiovascular disease. \u201cFor every 100 patients treated, we achieve success in terms of blood pressure control in only 33, lipid lowering in only 17, and weight loss in only 10 patients,\u201d she observed.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EClinicians can help motivate patients toward healthier lifestyles by focusing on one change at a time, keeping the message very simple and repeating it often, she said. They should also emphasize the immediate benefits of change, rather than the long-term goals. The immediate benefits of walking, for example, are the opportunity to breathe fresh air, undisturbed, and reflect on life and thus reduce stress. In addition, she advocates a \u201ccoping peer\u201d program that uses fellow patients as a support system for lifestyle modification.\u003C\/p\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\/1\/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_openurl.js?nzmbo2\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?nzmbo2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}