1 Introduction
WHO (1998) | AACE (2003) | NCEP-ATPIII (2005) | IDF (2005) | IDF;NHLBI;AHA;WHF;IAS;IASO Harmonizing definition (2009) | |
---|---|---|---|---|---|
Reference | [7] | [8] | [9] | [10] | [11] |
Requirement | IGT, IFG, T2D, or lowered insulin sensitivitya plus any 2 of the following | IGT or IFG plus any of the following based on clinical judgment | Any 3 of the following 5 features | Increased WC plus any 2 of the following | Three out of 5 would qualify a person for the metabolic syndrome |
Obesity | Men: WHR >0.90; Women: WHR >0.85 and/or BMI >30 kg/m2
| BMI ≥25 kg/m2
| WC ≥102 cm in men or ≥88 cm in women | Population-specific increased WC | Population- and country-specific WC cutoffsb
|
Triglycerides (TG) | TG ≥150 mg/dl | TG ≥150 mg/dl | TG ≥150 mg/dl or on TG lowering Rx | TG ≥150 mg/dl or on TG lowering Rx | TG ≥150 mg/dlc
|
HDL-cholesterol (HDL-C) | HDL-C <40 mg/dl in men or HDL-C <50 mg/dl in women | HDL-C <40 mg/dl in men or HDL-C <50 mg/dl in women | HDL-C <40 mg/dl in men or HDL-C <50 mg/dl in women on HDL-C increasing Rx | HDL-C <40 mg/dl in men or HDL-C <50 mg/dl in women on HDL-C increasing Rx | HDL-C <40 mg/dl in men or HDL-C <50 mg/dl in womenb
|
Blood pressure | ≥140/90 mmHg | ≥130/85 mmHg | ≥130/85 mmHg or on antihypertensive Rx | ≥130/85 mmHg or on antihypertensive Rx | ≥130/85 mmHg or on antihypertensive Rx |
Glucose | IGT, IFG, or T2D | IGT or lFG (but not diabetes) | ≥100 mg/dl (includes diabetes) | ≥100 mg/dl (includes diabetes) | ≥100 mg/dLd
|
2 Pathophysiologic features of metabolic syndrome
2.1 Insulin resistance
2.2 Pro-inflammatory state, oxidative stress, and renin-angiotensin system in metabolic syndrome
3 Pharmacological treatment of metabolic syndrome
Medications | Mode of action | Main target of metabolic syndrome | Additional benefit | Side effect | Ref. |
---|---|---|---|---|---|
Lorcaserin | Selective 5-HT 2C agonist | (Abdominal) obesity | TG ↓ | Attention deficit or memory problem | [43] |
LDL-C ↓ | |||||
Extended release phentermine + topiramate combination | Voltage-dependent sodium channels, glutamate receptors, and carbonic anhydrase, and augments the activity of γ-aminobutyrate | (Abdominal) obesity | Insulin sensitivity ↑ | Pulse rate ↑ | [44] |
Sustained release bupropion and naltrexone | Alterations in the hypothalamic melanocortin system and brain reward systems that influence food craving and mood | (Abdominal) obesity | Insulin sensitivity ↑ | Nausea | [45] |
Pulse rate ↑ | |||||
Blood pressure ↑ | |||||
Thiazolidinedione | Peroxisome proliferator-activated receptor-γ agonist | High glucose | TG ↓ | Fluid retention or weight gain | [46] |
HDL-C ↑ | Bone mineral density ↓ | ||||
Inflammation ↓ | |||||
Metformin | Increase in AMPK activity | High glucose | Inflammation ↓ | Gastrointestinal trouble | |
Lactic acidosis | |||||
Statins | HMG-CoA reductase inhibitor | High TG | LDL-C ↓ | Glucose ↑ | [37] |
Inflammation ↓ | Muscle weakness | ||||
Fibrates | Peroxisome proliferator-activated receptor-α agonist | High TG | Inflammation ↓ | Muscle side effect combined with statin | [47] |
Low HDL-C | |||||
ACE inhibitors/ARBs | Renin-angiotensin system blockers | High blood pressure | Inflammation ↓ | Cough with ACE inhibitor | [48] |
Insulin sensitivity ↑ | |||||
GLP-1 agonists | Stimulation of GLP-1 receptor | High glucose | Body weight ↓ | Gastrointestinal trouble | [49] |
Blood pressure ↓ | |||||
SGLT-2 inhibitors | Inhibition of glucose reabsorption in sodium glucose transporter-2 | High glucose | Body weight ↓ | Urinary tract and genital infection | [50] |
Blood pressure ↓ | |||||
Cilostazol | PDE3 inhibitor | – | TG ↓ | Bleeding tendency | [42] |
HDL-C ↑ | |||||
Inflammation ↓ |