Review: Cardiovascular risk assessment in the metabolic syndrome, screening for subclinical disease, and implications for treatment

Abstract

he metabolic syndrome is a clustering of risk factors known to promote or increase the risk for development of cardiovascular disease. Approximately 25—35% of the adult population of developed countries are characterised with metabolic syndrome by different definitions. Metabolic syndrome, even in the absence of diabetes, is associated with an increased risk of cardiovascular disease and total mortality, and is related to an increased risk for the development of diabetes. Initial evaluation of coronary heart disease risk involves global risk estimation using Framingham or other algorithms for risk prediction. Given the absence of key metabolic syndrome risk factors (namely obesity, elevated triglycerides, and impaired fasting glucose) in these algorithms, elevations in these factors need to be considered in individual patient risk evaluation. Further, consideration of screening for novel risk factors such as C-reactive protein, as well as subclinical atherosclerosis (from carotid ultrasound, computed tomography, or ankle-brachial index), can further refine the estimation of future cardiovascular disease risk. The presence of subclinical atherosclerosis or elevated levels of C-reactive protein can potentially modify recommended treatment goals for lipid and other cardiovascular risk factors. The American Heart Association and US National Heart Lung and Blood Institute have recently released revised guidelines for the diagnosis and clinical management of metabolic syndrome. This article examines global assessment of cardiovascular risk in persons with metabolic syndrome, the role of screening for subclinical disease in risk assessment, as well as treatment strategies and their implications for reducing cardiovascular risk in those with metabolic syndrome.