[Therapeutic options for treatment of cardiometabolic risk]

Numerous epidemiological and clinical studies have shown that increased amounts of fat mass, especially intra-abdominal adipose tissue are associated with various metabolic abnormalities. Dysregulation of adipocytokines secreted by adipose tissue may play an important role in the development of the obesity-associated metabolic syndrome, resulting in insulin resistance, type 2 diabetes, hypertension, hyperlipidemia, and vascular disease. The cardiometabolic risk describes the clustering of risk factors including dyslipidemia, insulin resistance, hypertension, prothrombotic and proinflammatory state, associated with an increased risk for development of cardiovascular disease and type 2 diabetes.

The treatment of cardiometabolic risk should include weight reduction, increased physical activity and lifestyle changes followed by pharmacotherapy to treat each risk factor individually. Anti-obesity drugs such as sibutramine and orlistat can be an option to reduce weight and central obesity and jointly control the metabolic abnormalities. Several agents are available for the treatment of lipid abnormalities, including fibrates, bile acid sequestrates, niacin and statins. Hypertension should be treated aggressively. Some investigators suggest that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBS) may be more beneficial for the treatment of hypertension in patients with metabolic syndrome, as these drugs also prevent development of diabetes. Pharmacotherapeutic options for diabetes treatment include metformin, sulfonylurea and insulin, and the newer glucagon-like peptide-1 and dipeptidyl peptidase-4 inhibitors.

Therapeutic options for the treatment of cardiometabolic risk include a multifactorial risk reduction for such individuals targeting each risk factor and emphasizing both lifestyle changes and pharmacologic therapy.