• Cardiometabolic Disorder
• Cardiometabolic Disorder

Roger 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:

Intensive 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—or “10,000 steps.” “These actions are just as important as giving aspirin or a cholesterol-lowering pill every day,” he remarked.

Gail 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.

In the optimal diet, calories should be appropriate for weight management. Carbohydrates should be <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.

Steven M. Haffner, MD, University of Texas Health Science Center, San Antonio, posed three “key questions” 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?

Unfortunately, the answers to these questions, at this point, are “ambiguous,” he said. The increase in coronary heart disease risk is “modest” 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.

Furthermore, 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. “For 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,” she observed.

Clinicians 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 “coping peer” program that uses fellow patients as a support system for lifestyle modification.

• © 2007 MD Conference Express