Fast Five Quiz: How Much Do You Know About Metabolic Syndrome?

Romesh Khardori, MD, PhD

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June 27, 2018

Management of elevated LDL-C levels includes consideration of all statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) at all indicated ranges, because several formulations with different doses and potencies are available. Statins affect the lipid profile favorably and provide possible pleiotropic benefits. The latest cholesterol guidelines from the American College of Cardiology emphasize the use of statins over nonstatin therapies, and recommend reemphasis on adherence to statin and lifestyle therapies before resorting to nonstatin therapies.

When lifestyle modifications fail, medical therapy for elevated triglycerides may include fibrates, although a distinction should be made between gemfibrozil and fenofibrate/fenofibric acid due to their different dosing patterns and different propensities for drug interactions, particularly if combined with a statin. The addition of omega-3 fatty acids to treatment is also likely to help lower triglyceride levels.

Management of reduced HDL-C remains controversial, but starts with diet/exercise modifications. Certain statins (such as rosuvastatin) may help, but this is not yet a widely accepted indication. Niacin raises low HDL-C levels and reduces cardiovascular events but may exacerbate hyperglycemia, especially in high doses (> 1500 mg/day).

For more on the pharmacologic treatment of patients with metabolic syndrome, read here.

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