Surgical risk in patients with metabolic syndrome: focus on lipids and hypertension

The metabolic syndrome describes a clustering of risk factors that predispose individuals to cardiovascular disease and type 2 diabetes mellitus. Abdominal obesity is a key component of the metabolic syndrome, increasing the incidence of insulin resistance, vascular inflammation, dyslipidemia, and hypertension. Adipose tissue (now recognized as an endocrine organ) and its hormonal products appear to play a significant role in signaling organs throughout the body in the regulation of fat and glucose metabolism. These mechanisms are clearly involved in the development of cardiovascular and metabolic disease and may also lead to increased surgical risks. The components of the syndrome that are most likely to affect surgical patients are obesity, hypertension, and disorders of glucose metabolism. This article focuses on each of these risk factors, the effects on surgical patients, and strategies to improve outcomes in the perioperative period.