doi: 10.1161/01.CIR.0000089506.12223.F1
(Circulation. 2003;108:1537.)
© 2003 American Heart Association, Inc.
Clinician Update |
The Metabolic Syndrome
A Practical Guide to Origins and Treatment: Part II
From the Framingham Heart Study of the National Heart, Lung, and Blood Institute, Boston, Mass.
Correspondence to Peter W.F. Wilson, MD, Department of Cardiology, Boston University School of Medicine, 715 Albany St, Evans 204, Boston, MA 02118. E-mail pwilson@bu.edu
Key Words: diabetes mellitus • screening • obesity
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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In this second part of discussing the components of the metabolic syndrome, we will discuss lipids and blood pressure criteria.
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Low HDL Cholesterol and Elevated Triglycerides |
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Background
It is appropriate to consider jointly the effects of low HDL cholesterol (HDL-C) and high triglyceride levels as components of the metabolic syndrome (MetS). In observational studies, each of these factors is related to greater risk of coronary heart disease,1,2 and clinical trials have been undertaken to prevent outcomes.3 Persons with high triglycerides often have low HDL-C levels and small, dense LDL particles. Estrogen therapy and excessive alcohol intake may disrupt this pattern, as each may cause simultaneous increases in HDL and triglyceride levels.
A variety of environmental and genetic factors have been related to HDL-C and triglyceride levels in certain populations. For instance, lower HDL-C levels are found in cigarette smokers, obese persons, inactive individuals, and those who use androgens or 17 nor-derivatives of progesterone.4,5 Genetic variants of lipoprotein lipase, hepatic lipase, cholesterol ester transfer protein, and peroxisome proliferator-activated receptors (PPAR)-
have been shown to have effects on HDL-C and triglyceride levels in populations,6–10 contributing to the development of the MetS.
How Do You Make the Diagnosis?
Lipid levels are best obtained in a person’s usual, healthy state.11,12 Blood concentrations after a recent illness such as influenza, diarrhea, or a systemic disease accompanied by weight loss may reduce lipoprotein cholesterol levels, and physicians should be aware that it may be advisable to defer lipoprotein testing until acute illnesses have passed and the patient has recovered. A low HDL-C level (<40 mg/dL in men and <50
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