Metabolic syndrome

Metabolic syndrome

Most of the diseases of aging develop much earlier in life. They have their
roots in genetic makeup, unhealthy habits acquired when young, and environmental
influences. They smolder along subclinically in middle age, only
to become clinically manifest in old age. Thus good health in old age depends
on preventive treatment in middle age and earlier. The emergence
of the metabolic syndrome as a distinct entity is a classic example [3]. It is
a constellation of abnormalities that commonly occur together in middle
age and increase the risk of type 2 diabetes mellitus and cardiovascular disease
in old age. The presence of three of the five following measurements defines
the metabolic syndrome: (1) abdominal obesity (waist circumferenceO
40 in for men andO35 in for women), (2) insulin resistance with high fasting
blood glucose (O110 mg/dL), (3) elevated triglycerides, (4) low levels of
high-density lipoprotein (HDL or ‘‘good cholesterol’’), and (5) hypertension.
The three major treatment approaches for the metabolic syndrome
are: (1) from the National Cholesterol Education Program Adult Treatment
Panel III (NCEP ATP III), reducing obesity and increasing physical activity;
(2) from the World Health Organization (WHO), administration of insulin
sensitizers, thiazolidinediones or ‘‘glitazones’’ such as pioglitazone or rosiglitazone
; and (3) from emerging research that inflammation plays a major
role and that remodeling is possible, statins, angiotensin-converting enzyme
(ACE) inhibitors, and angiotensin receptor blockers (ARBs).