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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\u003EWhat was once known as \u201cSyndrome X\u201d has grown into a clinical entity known as Metabolic Syndrome (MetS). Now understood to be a complex interaction of several metabolic variables that, in combination, exacerbate hypertension, coronary artery disease, and diabetes, MetS is one of the most important health burdens in the developed world. As research progresses, metabolic syndrome appears to have biochemical and causal relationships with many unexpected abnormalities (asthma, gout, polycystic ovary disease) as well as with behavioral conditions such as depression and chronic hostility and anger.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiometabolic\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epolycistic ovary (Diabetes)\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EWhat was once known as \u201cSyndrome X\u201d has grown into a clinical entity known as Metabolic Syndrome (MetS). Now understood to be a complex interaction of several metabolic variables that, in combination, exacerbate hypertension, coronary artery disease, and diabetes, MetS is one of the most important health burdens in the developed world. As research progresses, metabolic syndrome appears to have biochemical and causal relationships with many unexpected abnormalities (asthma, gout, polycystic ovary disease) as well as with behavioral conditions such as depression and chronic hostility and anger.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMetS: Synergy of Components or Syndrome?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cResearch on metabolic syndrome (MetS) has seen enormous growth in the last few years,\u201d said David C. Goff, Jr., MD, PhD, co-director of the Center for Health Care Research and Quality and a professor of Public Health Sciences and Internal Medicine at the Wake Forest University School of Medicine in Winston-Salem, NC.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAlthough MetS now has its own journal, \u003Cem\u003EMetabolic Syndrome and Related Disorders,\u003C\/em\u003E and a recent PubMed search for MetS yielded nearly 15,000 citations, Dr. Goff observed that \u201cwe are still not certain MetS is actually a syndrome.\u201d Pointing to several papers including an October 2005 position paper sponsored by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Dr. Goff acknowledged that some researchers believe MetS does not yet meet the formal definition of a syndrome.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003E\u201cSome of our colleagues maintain that MetS is a \u2018synergy of components\u2019 rather than a true syndrome,\u201d Dr. Goff said. But the fact remains that \u201cthe existing data makes it clear the converging elements of MetS help to identify individuals at high risk for cardiovascular disease (CVD) and type 2 diabetes (T2DM).\u201d Whether these factors collaborate to exacerbate the various conditions associated with MetS, or exist in tandem as independent risk factors, Dr. Goff noted that \u201cstudies generally agree there is a stepwise increase of risk\u201d as each additional element of MetS is identified in a patient.\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\/5\/1\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-775552044\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/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\/5\/1\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\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\/5\/1\/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\/16079\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\n         \u003Cp id=\u0022p-6\u0022\u003EMetS is recognized as significant risk predictor of CHD, and is now thought to be an expression of genetic phenotype exacerbated by behavioral factors\u2014sedentary lifestyle, smoking, and being either overweight or obese. As new data accumulates, other conditions have been linked to MetS, not only biochemical factors such as oxidative stress, inflammation, and autonomic dysregulation, but depressive symptoms and negative affective states including chronic anger, hostility, and mood disorders.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\u201cThere is clearly more going on with MetS than simply the sum of its parts,\u201d Dr. Goff said. \u201cAnd it seems clear, whether we call it a syndrome or simply a connected set of conditions, MetS is going to become an ever more challenging problem.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPhysical Activity and Metabolic Syndrome\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EGerald Fletcher, MD, of the Mayo Clinic in Jacksonville, FL, offered a keynote presentation on MetS and exercise. \u201cPhysical activity is absolutely critical in primary prevention,\u201d Dr. Fletcher said. \u201cThe aspects of MetS impacted by exercise include blood pressure, elevated triglycerides, low HDL, and glucose tolerance. And the data is unequivocal: exercise reduces MetS, reduces risk, and limits cardiovascular events.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDr. Fletcher reported that average blood pressure reductions of 2.4 mm\/Hg (systolic) and 5.8 mm\/Hg (diastolic) were observed across several recent studies of exercise and metabolism. In citing other recent data published in \u003Cem\u003ECirculation\u003C\/em\u003E (LaMonte MJ et al. CIRC 2005; 112:505\u2013512), he noted that decreased cardiorespiratory fitness is strongly associated with MetS, saying that \u201clow cardiorespiratory fitness is a strong and independent predictor of MetS in both women and men.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe best exercise programs combine moderate intensity and endurance, and should be an activity that a patient can live with for the rest of their life. \u201cIt\u0027s best to recommend varied intensity in any single exercise session,\u201d Dr. Fletcher said. \u201cThe key is consistency and regularity rather than exercising to exhaustion 1 or 2 days a week.\u201d Dr. Fletcher\u0027s official advice: 30\u201360 minutes of moderate intensity exercise \u201con most days\u201d for weight control and maintenance of target weight. Patients should be cautioned to avoid more than 2\u20133 weeks of \u201cexercise abstinence,\u201d as it takes up to 6 weeks to re-condition to prior levels after 2\u20133 weeks of no activity.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EUltimately, Dr. Fletcher said that \u201cpatients must be encouraged to assume responsibility and physicians must serve as examples and champions for exercise. We all just need to move more and do more.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPsychological and Novel Risk Factors\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EAs research continues, MetS has been linked to depression, sleep apnea, asthma, polycystic ovary syndrome, gestational diabetes, and gout.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003ESome researchers have postulated the existence of a \u201cvascular depression,\u201d where depression is more difficult to treat in the presence of CAD. According to Viola Vaccarino, MD, PhD, Associate Professor at Emory University School of Medicine in Atlanta, GA, depression affected neurohormonal pathways contribute to a \u201cstress cascade,\u201d driving cortisol levels above baseline and furthering changes that predispose to diabetes, sodium retention, hypertension, as well as the truncal adiposity associated with dyslipidemia and MetS.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDr. Vaccarino reported findings of her study of 281 male twins born from 1945\u20131955. Study data yielded a correlation between major depression (at least 1 incident) and subsequent development of MetS\u2014a connection that appears to be independent of behavioral and environmental factors. Dr. Vaccarino postulated that depression and mood disorders may be linked to the development of MetS and increased CAD risk through stress-induced neuroendocrine pathways.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EMercedes Carnethon, PhD, professor of preventive medicine at Northwestern University in Chicago, IL, discussed novel risk factors that appear to enhance development of MetS, including sleep disturbances (insomnia, sleep apnea), and behavioral factors such as depression, anxiety, and hostility. Dr. Carnethon also reviewed recent studies that link inflammation and endothelial dysfunction, diabetes, depression, MetS, and CAD risk.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EDr. Carnethon noted that smoking\u2014a major risk factor for both MetS and CAD\u2014is associated with insulin resistance. \u201cWe are dealing with a constellation of factors involving both physiological and behavioral elements,\u201d she said. \u201cWe have seen evidence that both oxidative stress and autonomic dysfunction contribute to MetS as well as depression and anxiety. More research is needed to help us understand how to intervene in this complex problem.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIs There a Rational Drug Therapy Treatment for MetS?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EAccording to Alan Chait, MD, Professor of Medicine and Head, Division of Metabolism, Endocrinology and Nutrition at the University of Washington, Seattle, the components of MetS are treated independently. \u201cThe ideal treatment for metabolic syndrome will be to treat the syndrome at the biochemical source and block all downstream manifestations. This is where we need to go in the future. This is where our research needs to point.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EChait acknowledged that \u201cTLC\u201d (therapeutic lifestyle changes) is always the first step in managing a patient with one or more elements of MetS. But all too often TLC fails to arrest dyslipidemia, hypertension, and impaired fasting glucose. Chait focused on the dyslipidemic aspects of MetS, referring to the HDL-Atherosclerosis Treatment Study (HATS), which assessed a combination of simvastatin plus niacin in 160 patients with documented CAD and low HDL levels. Nearly half of the study participants had MetS based on NCEP ATP III criteria. In those participants with MetS, the simvastatin + niacin treatment led to 40% reduction in CAD events and 90% reduction in coronary artery stenosis. (Brown BG et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2001; 345: 1583\u201392.)\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EDr. Chait reviewed considerations for treatment of dyslipidemias, particularly the combination of elevated triglyceride (TG) and lowered HDL that marks MetS. Since statins tend to have a lesser effect on TG and HDL, niacin or fibrates used in combination with a statin may be indicated.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EIn general, Dr. Chait noted that \u201catorvastatin in combination with fibrates offer excellent outcomes\u201d in patients with MetS. \u201cBut the ideal treatment - one we hope our research takes us toward - will treat the cause of MetS, not the expressions. Until then, we must aggressively treat all modifiable risk factors for this condition.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\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\/5\/1\/24\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-775552044\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/5\/1\/24\/F2.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\/5\/1\/24\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\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\/5\/1\/24\/F2.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\/16080\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\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2005 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\/5\/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_figures.js?nzm47q\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?nzm47q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}