What is the role of medications in the treatment of metabolic syndrome?

Updated: Mar 30, 2020
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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An insulin-sensitizing agent, such as metformin, is typically used at the start of hyperglycemia treatment in patients with metabolic syndrome. Some literature suggests that metformin may help to reverse the pathophysiologic changes of metabolic syndrome. This includes when it is used in combination with lifestyle changes [102] or with peroxisome proliferator-activated receptor agonists, such as fibrates [103] and thiazolidinediones (eg, pioglitazone, rosiglitazone), [104, 105] each of which may produce favorable metabolic alterations as single agents in patients with metabolic syndrome. [106]

When statin therapy and therapeutic lifestyle modifications are not successful, niacin may aid in the management of reduced HDL-C and in the treatment of elevated triglycerides.

Aspirin may contribute to the primary prevention of cardiovascular complications in metabolic syndrome, particularly in patients with at least an intermediate risk of suffering a cardiovascular event (ie, >6% 10-y risk). [108, 109]

Additional therapies have found early support from more recent data. For example, a small trial of high-dose resveratrol therapy (1000 mg daily) was found to lead to greater new bone formation and mineralization in men with MetS. [131, 132]

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