Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.
Conquering the Ravages of Metabolic Syndrome
To provide cardiologists, endocrinologists, and primary care physicians with up-to-date information on the diagnosis and treatment of patients with metabolic syndrome.
This activity is designed for cardiologists, endocrinologists, and primary care physicians.
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:
- Discuss causes of the recent increase in the prevalence of metabolic syndrome, stressing the importance of detection, evaluation, and treatment of high blood cholesterol in adults.
- Provide an overview of the pathophysiology of lipids and lipoproteins.
- Indicate effective treatment strategies according to the National Cholesterol Education Program Adult Treatment Panel III guidelines.
- Implement the United States Preventive Services Task Force recommendations in the screening for lipid disorders.
- Explain the benefits of omega-3 fatty acids, focusing on the American Heart Association recommended intake and US Food and Drug Administration approval for updated food labels.
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
The estimated time to complete this educational activity: 2 hours.
Release date: June 15, 2005. Expiration date: June 15, 2007.
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
This program is supported by an educational grant from Reliant Pharmaceuticals, Inc.
Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Directors and Participating Faculty reported the following:
Roger S. Blumenthal, MD
Associate Professor of Medicine
Department of Medicine-Cardiovascular
Johns Hopkins Ciccarone Center
Johns Hopkins University School of Medicine
• Dr Blumenthal reports receiving grants/research support and honoraria from AstraZeneca, KOS Pharmaceuticals Inc, Merck and Company, Novartis, Pfizer Inc, and Wyeth.
Michael H. Davidson, MD
Director of Preventive Cardiology
Rush University Medical Center
• Dr Davidson reports receiving grants/research support, honoraria, and serving as a consultant for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb Company, KOS Pharmaceuticals Inc, Merck and Company, Merck/Schering-Plough, Novartis, Pfizer Inc, Reliant Pharmaceuticals Inc, Sankyo Pharma, Sumitomo Pharmaceuticals, and Takeda Pharmaceuticals.
Emma Meagher, MD
Cardiovascular Risk Intervention Program
Department of Pharmacology
University of Pennsylvania School of Medicine
• Dr Meagher reports serving as a consultant for Bristol-Myers Squibb Company, KOS Pharmaceuticals Inc, Novartis, and Reliant Pharmaceuticals Inc; and receiving honoraria from Bristol-Myers Squibb Company, KOS Pharmaceuticals Inc, Novartis, and Reliant Pharmaceuticals Inc.
Philippe O. Szapary, MD, MSCE
Assistant Professor of Medicine
Division of General Internal Medicine and Cardiovascular Risk Intervention Program
University of Pennsylvania School of Medicine
• Dr Szapary reports having no significant financial or advisory relationships with corporate organizations related to this activity.
Notice: The audience is advised that an article in this CME activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.
Dr Szapary—fish oils for cardiovascular risk reduction.
All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.
Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.
Recognition and Management of the Metabolic Syndrome: Focus on Dyslipidemia
Roger S. Blumenthal, MD*
More than 1 in 5 adults in the United States have the metabolic syndrome, a cluster of cardiovascular and metabolic abnormalities that include obesity, atherogenic dyslipidemia, insulin resistance, and hypertension. The metabolic syndrome is a risk factor for 2 major diseases that have high mortality rates: type 2 diabetes mellitus and cardiovascular disease. This monograph discusses recognition and management of the metabolic syndrome with a focus on dyslipidemia.
Dyslipidemia, a cardinal component of the metabolic syndrome, is a well-established risk factor for cardiovascular disease. The metabolic syndrome is characterized by mixed dyslipidemia including elevated low-density lipoprotein cholesterol, elevated triglycerides, and low high-density lipoprotein cholesterol.
Changes in the quality and quantity of specific lipoproteins constitute one of the earliest manifestations of the insulin resistance syndrome. The onset of lipoprotein abnormalities in cardiovascular disease and type 2 diabetes mellitus occurs substantially earlier than other manifestations of these conditions. Lipoprotein abnormalities predate the onset of clinically manifest type 2 diabetes mellitus, in addition to diabetic macrovascular and microvascular complications (Figure). These early changes in lipoproteins are important because they can contribute to the development of cardiovascular disease and serve as a marker for cardiovascular and metabolic risk, thus affected individuals can be identified for early intervention.
The metabolic syndrome is becoming increasingly common as the US population ages, the prevalence of obesity rises, and people become more sedentary. In 2002, the authors of the seminal Kuopio Ischaemic Heart Disease Risk Factor Study noted that “the threat to public health posed by the metabolic syndrome will continue to grow as the metabolic syndrome becomes more common. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for physicians and public health policy makers facing an epidemic of overweight and sedentary lifestyle.”1
Early identification, treatment, and prevention of the metabolic syndrome are achievable goals. The manifestations of the metabolic syndrome can be assessed and identified in clinical practice. The cardiovascular and metabolic risk factors comprising the metabolic syndrome are modifiable through diet, exercise, and pharmacotherapy. The goal of this monograph is to assist the healthcare professional in the recognition and management of the metabolic syndrome in clinical practice. This author discusses the importance of early recognition of the metabolic syndrome, and considers the prevalence and clinical significance of the metabolic syndrome and the role of lipid and lipoprotein abnormalities in conferring cardiovascular and metabolic risk.
Dr Michael H. Davidson discusses clinical management of the metabolic syndrome with particular emphasis on management of dyslipidemia, and includes a review of the National Cholesterol Education Program’s Adult Treatment Panel III guidelines for the management of dyslipidemia in the metabolic syndrome through diet, exercise, and pharmacotherapy. Dr Philippe O. Szapary focuses on a dietary strategy that has recently garnered attention as a means of improving cardiovascular risk. He reviews the evidence on the cardiovascular risk-reducing properties of omega-3 fatty acids and discusses the hypothesized mechanisms by which omega-3 fatty acids may reduce cardiovascular risk.
Dr Emma A. Meagher discusses a case study of a patient with the metabolic syndrome and atherogenic dyslipidemia.
We hope that healthcare providers will find the information in this monograph useful in improving the ability to provide quality care for patients who are at risk for developing cardiovascular and metabolic disease.
1. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709-2716.
*Associate Professor of Medicine, Department of Medicine-Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Roger S. Blumenthal, MD, Associate Professor of Medicine, Department of Medicine– Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, 600 North Wolfe Street–Blalock 524 C, Baltimore, MD 21287. E-mail: firstname.lastname@example.org..