NCEP-ATP III

Etiology and Treatment of the Metabolic Syndrome and its Components According to NCEP-ATP III

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Increasing physical activity can also speed the process. Current recommendations include at least 30 minutes of moderate-intensity physical activity/exercise, such as brisk walking, most days of the week. Increasing exercise duration and frequency can cause even greater weight loss and have a positive impact on cardiometabolic risk alterations found in patients with excess intra-abdominal fat. Since waist circumference is a crude marker of abdominal obesity, NCEP-ATP III suggests measuring waist circumference as a key criterion to diagnose the metabolic syndrome.

Beyond elevated LDL cholesterol, the atherogenic dyslipidemia of the metabolic syndrome has been identified as a marker of abnormal lipolytic activity of intra-abdominal adipose tissue and associated ectopic fat deposition. These markers include elevated triglyceride and apolipoprotein B levels, higher amounts of triglyceride-enriched small, dense LDL and HDL particles, and low HDL cholesterol. In the proposed criteria for diagnosing the metabolic syndrome, fasting triglycerides should be equal to or above 1.7 mmol/l (150 mg/dl) (or the patient should be on drug treatment for elevated triglycerides) and HDL cholesterol levels should be below 1.04 mmol/l (40 mg/dl) in men and below 1.29 mmol/l (50 mg/dl) in women (or the patient should be on drug treatment for low HDL cholesterol) (1). Although the primary target is elevated LDL cholesterol levels (even in the metabolic syndrome), the secondary therapeutic target of the atherogenic dyslipidemia of the metabolic syndrome is non-HDL cholesterol (total cholesterol minus HDL cholesterol, which includes the cholesterol associated with the atherogenic lipoproteins VLDL, IDL, and LDL). To achieve non-HDL cholesterol goals, patients can benefit from intensive LDL cholesterol-lowering therapy or from adding a fibrate or nicotinic acid to their current pharmacological treatment.

Reference

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1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

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