Direkter Einfluss des Metabolischen Syndroms auf das kardiovaskuläre Risiko

Das Metabolische Syndrom gilt als wichtige Vorstufe sowohl für den Typ 2-Diabetes als auch für kardiovaskuläre Erkrankungen und ist damit, trotz Fehlen einer einheitlichen Definition, von enormer sozialer und medizinischer Bedeutung. Anstatt des Body Mass Index (BMI) wurde 2001 vom amerikanischen National Cholesterol Education Programm (NCEP-ATP III) der Bauchumfang vorgeschlagen, um die Bedeutung des viszeralen Fetts als Risikomarker zu betonen. An der Entwicklung des Metabolischen Syndroms sind genetische Faktoren, falsche Lebensgewohnheiten und negative Umweltfaktoren beteiligt. Eine enge Beziehung zwischen der Insulinresistenz und der kompensatorischen Hyperinsulinämie besteht zur Adipositas (insbesondere dem androiden Fettverteilungstyp), zur Glukoseintoleranz (Typ 2-Diabetes), Dyslipidämie (Hypertriglyzeridämie, erniedrigte HDL-Cholesterinspiegel) und der arteriellen Hypertonie. Als Leitsymptom des Metabolischen Syndroms gilt die abdominelle Adipositas, die die Insulinresistenz verstärkt und zum klinisch manifesten Typ 2-Diabetes führt. So weist bereits bei Diagnose eines Typ 2-Diabetes ein großer Prozentsatz der Patienten kardiovaskuläre Risikofaktoren und eindeutige Zeichen der Arteriosklerose auf. Neben den klassischen kardiovaskulären Risikofaktoren bedeutet das Vorliegen eines Metabolischen Syndroms eine weitere Risikosteigerung für Herzinfarkt, Herzinsuffizienz, AVK und Schlaganfall.

Metabolic syndrome is considered to be a major precursor both of type 2 diabetes and cardiovascular diseases, and, despite the absence of a uniform definition, is thus of enormous social and medical significance. In 2005, the International Diabetes Federation (IDF) proposed replacing the body mass index (BMI) by waist circumference, in order thus to emphasise the importance of visceral fat as a risk marker. Genetic factors, a poor (sedentary) lifestyle and negative environmental factors are all involved in the development of the metabolic syndrome. There is a close relationship between insulin resistance and compensatory hyperinsulinaemia on the one hand, and obesity (in particular the android fat distribution type) and glucose intolerance (type 2 diabetes), dyslipidaemia (hypertriglyceridaemia, lowered HDL cholesterol levels) and arterial hypertension on the other. The leading sign of the metabolic syndrome is abdominal adiposity, which aggravates insulin resistance and leads to clinically manifest type 2 diabetes. Thus a large percentage of patients with type 2 diabetes already have cardiovascular risk factors and unequivocal signs of arteriosclerosis. In addition to the classical cardiovascular risk factors the metabolic syndrome is a further risk enhancement for myocardial infarction, heart failure, arterial occlusive disease and stroke.

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