Pharmacologic therapy for cardiovascular risk reduction in patients with the metabolic syndrome

The metabolic syndrome (MetS) is associated with a higher risk for both, type 2 diabetes mellitus and cardiovascular disease. The cornerstone of treatment is lifestyle modification, encompassing weight reduction and physical exercise. However, pharmacotherapy is usually also required to achieve the recommended target values for the various components of the MetS, such as hypertension, dysglycemia and dyslipidemia. Regarding lipid treatment, statins are the main therapeutic agents while in blood pressure control a significant amount of pathophysiological and clinical evidence would suggest the use, as first line agents, of ACE inhibitors or angiotensin receptor blockers. Metformin seems to be the drug of choice for dysglycemia, specially since recent evidence questions the safety of thiazolidinediones. New drugs, targeting multiple components of the MetS, are under development but no data are currently available regarding their long-term efficacy and safety profile. In general, a multifactorial approach is recommended to decrease cardiovascular risk in patients with the MetS.