The metabolic syndrome - What is it and how should it be managed?
The metabolic syndrome - What is it and how should it be managed?
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DOI：
10.1177/2047487319886404
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发表时间：
2019-12-01
影响因子：
8.3
通讯作者：
Ryden, Lars
中科院分区：
文献类型：
--
作者：
Nilsson, Peter M.;Tuomilehto, Jaakko;Ryden, Lars
一组代谢因素已经被合并成一个名为代谢综合征的实体。虽然这种综合征的特征随着时间的推移而变化，但目前使用的定义是在2009年建立的。五个组成部分中有三个异常结果的存在使一个人符合代谢综合征的条件：腰围增加，甘油三酯升高，高密度脂蛋白胆固醇降低，血压升高和空腹血糖升高。除腰围外，所有组成部分都确定了分界点，腰围采用国家或区域数值。代谢综合征可预测心血管疾病和2型糖尿病。这种相关风险不超过其组成部分，其中血压升高是最常见的。然而，一个成功的管理应该解决所有相关因素。管理总是基于健康的生活方式的选择，但并不罕见的药物治疗，特别是降血压药物的支持。代谢综合征是一个有用的例子，说明了预防干预的多个目标的重要性。要成功的管理必须是个性化的，尤其是在药物治疗方面。体弱的老人不应被过分对待。风险因素如何作用的知识转让应伴随着持续的信任建设和激励。在复杂的情况下，生物风险因素、不利的社会条件和不健康的生活方式交织在一起，不可能一下子改变一切。最好是采取持久的小步骤，而不是采取不可持续的大步骤，重新采取不健康的行为。患有代谢综合征的人总是会受到其成分的影响，这就是管理必须持续很长时间的原因。本文就代谢综合征及其治疗的最新进展作一综述。
A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.