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Pharmacological treatment and therapeutic perspectives of metabolic syndrome

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Abstract

Metabolic syndrome is a disorder based on insulin resistance. Metabolic syndrome is diagnosed by a co-occurrence of three out of five of the following medical conditions: abdominal obesity, elevated blood pressures, elevated glucose, high triglycerides, and low high-density lipoprotein-cholesterol (HDL-C) levels. Clinical implication of metabolic syndrome is that it increases the risk of developing type 2 diabetes and cardiovascular diseases. Prevalence of the metabolic syndrome has increased globally, particularly in the last decade, to the point of being regarded as an epidemic. The prevalence of metabolic syndrome in the USA is estimated to be 34 % of adult population. Moreover, increasing rate of metabolic syndrome in developing countries is dramatic. One can speculate that metabolic syndrome is going to induce huge impact on our lives. The metabolic syndrome cannot be treated with a single agent, since it is a multifaceted health problem. A healthy lifestyle including weight reduction is likely most effective in controlling metabolic syndrome. However, it is difficult to initiate and maintain healthy lifestyles, and in particular, with the recidivism of obesity in most patients who lose weight. Next, pharmacological agents that deal with obesity, diabetes, hypertension, and dyslipidemia can be used singly or in combination: anti-obesity drugs, thiazolidinediones, metformin, statins, fibrates, renin-angiotensin system blockers, glucagon like peptide-1 agonists, sodium glucose transporter-2 inhibitors, and some antiplatelet agents such as cilostazol. These drugs have not only their own pharmacologic targets on individual components of metabolic syndrome but some other properties may prove beneficial, i.e. anti-inflammatory and anti-oxidative. This review will describe pathophysiologic features of metabolic syndrome and pharmacologic agents for the treatment of metabolic syndrome, which are currently available.

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Abbreviations

CVD:

cardiovascular disease

HDL-C:

high-density lipoprotein cholesterol

α-MSH:

S-melanocyte-stimulating hormone

GLP-1:

glucagon like peptide-1

SGLT-2:

sodium glucose transporter-2

hsCRP:

high sensitivity C-reactive protein

IL-6:

interleukin 6

TNF-α:

tumor necrosis factor-α

IRS:

insulin-receptor substrate

FDA:

Food and Drug Association

TZD:

Thiazolidinedione

PPARγ:

peroxisome proliferator-activated receptor-γ

PDX-1:

pancreas duodenum homeobox-1

HMG-CoA:

3-hydroxy-3- methylglutaryl- coenzyme A

ACE:

angiotensin-converting enzyme

ARBs:

angiotensin II receptor blockers

ICAM:

intracellular adhesion molecule

VCAM:

vascular cell adhesion molecule

cAMP:

cyclic adenosine monophosphate

PKA:

protein kinase A

MAPK:

mitogen-activated protein kinase

eNOS:

endothelial nitric oxide synthase

NO:

nitric oxide

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-city, 463-707, South Korea

    Soo Lim

  2. Division of Endocrinology, Diabetes and Metabolism and Division or Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 East 17th Ave., RC1 South, Room 7107, Aurora, CO, 80045, USA

    Robert H. Eckel

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Lim, S., Eckel, R.H. Pharmacological treatment and therapeutic perspectives of metabolic syndrome. Rev Endocr Metab Disord 15, 329–341 (2014). https://doi.org/10.1007/s11154-014-9298-4

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