Authors: Jacobson, T. A.¹; Case, C. C.²; Roberts, S.³; Buckley, A.³; Murtaugh, K. M.⁴; Sung, J. C. Y.⁵; Gause, D.⁵; Varas, C.⁶; Ballantyne, C. M.²

Source: Diabetes, Obesity and Metabolism, Volume 6, Number 5, September 2004 , pp. 353-362(10)

Publisher: Wiley-Blackwell

Abstract:

Background: 

The third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program defines clinical criteria for diagnosis of the metabolic syndrome, which increases cardiovascular risk and is a target for therapy. Aim: 

We analysed the third National Health and Nutrition Examination Survey (NHANES III; 1988-94) to determine how many US adults meet these criteria and are recommended for lipid-modifying drug therapy by ATP III. Methods: 

NHANES III data were used to estimate the number of individuals with the metabolic syndrome and the number recommended for treatment by ATP III, based on 1990 census data. Results: 

An estimated 36.3 million (23%) US adults have the metabolic syndrome. Of these, 84% met the criterion for obesity, 76% for blood pressure, 75% for HDL-C, 74% for triglycerides and 41% for glucose. Most (54%) are in the higher risk categories of ATP III, yet only 39% overall are recommended for drug therapy by ATP III cutpoints; of these, most will achieve LDL-C targets with reductions of 35-40%. Of the 15.3 million individuals with the metabolic syndrome and triglycerides ≥2.26 mmol/l (200 mg/dl), non-HDL-C is above ATP III recommendations in 11.6 million. Conclusions: 

Of the large number of Americans with the metabolic syndrome, ATP III recommends drug therapy for only a minority, because LDL-C typically is not substantially elevated. Instead, high triglycerides and low HDL-C are more common; clinical trial data are needed to determine whether optimal therapy should focus on reductions in LDL-C or on comprehensive improvements to the lipid profile.

Keywords: drug therapy; metabolic syndrome; treatment guidelines

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1462-8902.2004.00354.x

Affiliations: 1: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA 2: Department of Medicine, Baylor College of Medicine, Houston, TX, USA 3: PPD Development, Wilmington, NC, USA 4: Reliant Pharmaceuticals, LLC, Liberty Corner, NJ, USA 5: Novartis Health Economics and Outcomes Research, East Hanover, NJ, USA 6: Novartis Global Epidemiology, Barcelona, Spain

Publication date: 2004-09-01

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