Management of dyslipidemia in patients with metabolic syndrome.

OBJECTIVE: To review the management of dyslipidemia in patients with metabolic syndrome. DATA SOURCES: Medline search (2000-2002) conducted for English language articles using the search terms metabolic syndrome, impaired fasting glucose, glucose intolerance, and antilipemic agents; selective search for clinical trials of lipid therapy conducted in dialogue databases (1990-2002). In addition, current dyslipidemia treatment guidelines reviewed. STUDY SELECTION: By the author. DATA EXTRACTION: By the author. DATA SYNTHESIS: The metabolic syndrome is increasingly recognized as a strong predictor of patient risk for developing coronary artery disease (CAD). It is associated with an atherogenic dyslipidemia characterized by elevated levels of triglycerides, reduced levels of high-density lipoprotein cholesterol (HDL-C) and a preponderance of small dense low-density lipoprotein (LDL) particles. Controlled clinical trials show similar or greater cardiovascular benefits from lipid-modifying therapies in patient subgroups with diabetes, impaired fasting glucose, and metabolic syndrome, compared with overall study populations. Current guidelines recommend intensified lipid management. Therapeutic lifestyle changes, with emphasis on weight loss, are particularly important for patients with metabolic syndrome. Statins are first-line therapy for all patients whose LDL-C levels are above goal. Combination therapy may often be necessary to control all lipid abnormalities adequately. Both niacin and fibrates provide additional benefits, particularly on triglyceride and HDL-C levels. Recent clinical studies show that these agents, in combination with statins, are safe and effective for the treatment of atherogenic dyslipidemia.
CONCLUSION: Atherogenic dyslipidemia represents an important modifiable CAD risk factor. Combination therapy with agents that focus on all of the components of the mixed dyslipidemia that often occurs in persons with diabetes and the metabolic syndrome may be expected to reduce cardiovascular morbidity and mortality.