Highlights From The First World Congress on the Insulin Resistance Syndrome

Zachary T. Bloomgarden, MD


January 29, 2004

In This Article

Case Presentation: Approaches to Lipid Treatment in the IRS

Drs. Krauss and Pasternak gave a case presentation illustrating approaches to lipid treatment for persons with the IRS.[46]

The patient described was an asymptomatic 56-year-old man whose father had diabetes and died of myocardial infarction at age 62. The patient's BMI was 31 kg/m2, abdominal girth 42 cm, blood pressure 130/82 mm Hg, cholesterol 215 mg/dL, LDL 125 mg/dL, HDL 38 mg/dL, and fasting glucose 112 mg/dL. These measures yield a Framingham 10-year risk of 6%, but satisfy the ATP III criteria for metabolic syndrome.

Should initial treatment be with diet/exercise, or pharmacotherapy? And if pharmacotherapy is recommended, should it be directed at HDL, LDL, or glycemia?

Drs. Krauss and Pasternak suggested that lifestyle modification alone would be appropriate as initial treatment, and pointed out that suggesting drug treatment might make the patient feel less inclined to comply with lifestyle modification.

After 4 months, the patient had lost 10 pounds but had eliminated fat rather than carbohydrate from his diet. He still had abdominal obesity; his fasting glucose was 106 (below the ATP III definition of impaired fasting glucose but above the new ADA criterion of 100 mg/dL), total cholesterol was 210, HDL 39, triglyceride 245, and LDL 122 mg/dL. On the basis of the patient's non-HDL cholesterol of 171 (this measurement should be used because of the triglyceride of 245), pharmacologic treatment was indicated. Atorvastatin was administered, with reduction in total, LDL, non-HDL, and HDL cholesterol to 160, 80, 119, and 41, respectively.