Management of Cardiometabolic Syndrome in the Primary and Secondary Prevention of Cardiovascular Disease

M. Dominique Ashen, PhD, CRNP

Disclosures

Journal for Nurse Practitioners. 2008;4(9):673-680. 

In This Article

Abstract and Case Studies

Abstract

Cardiometabolic syndrome (CMS) is a clustering of interrelated risk factors that promote the development of atherosclerotic vascular disease and type 2 diabetes mellitus. These interrelated risk factors have a direct effect on atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose, and promote proinflammatory and prothrombic states. Mechanisms of the major underlying forces of CMS—abdominal obesity and insulin resistance—are discussed and include review of obesity-induced inflammation with the development of abdominal obesity. Two clinical case studies are presented for primary and secondary cardiovascular disease patients with discussion of clinical management based on guideline recommendations.

Case Studies

Case Study 1. A 52-year-old female with dyslipidemia and a family history of premature coronary artery disease (CAD) and type 2 diabetes mellitus (DM; mother is diabetic with CABG at 56 and PCI/stent at 70). She denies cigarette smoking, exercises only occasionally, and does not pay attention to her diet. She does not take prescription medications. Her blood pressure is 142/78 mmHg, body mass index 27, and waist circumference 38 inches. The fasting glucose level is 98 mg/dL. The total cholesterol level is 220 mg/dL, the low-density lipoprotein cholesterol (LDL-C) level is 168 mg/dL, the high-density lipoprotein cholesterol (HDL-C) level is 38 mg/dL, and the triglyceride level is 68 mg/dL.

Case Study 2. A 65-year-old male with dyslipidemia, hypertension, and a history of PCI/stent 4 years previously. There is no known family history of coronary heart disease or type 2 DM. He was a former smoker (1 pack/day; quit after PCI). He follows a low saturated fat diet but never exercises. Medications include a statin, a beta-blocker, an angiotensin-converting–enzyme inhibitor, and aspirin. His blood pressure is 146/86 mmHg, body mass index is 29, and waist circumference is 43 inches. The fasting glucose level is 99 mg/dL. The total cholesterol level is 191 mg/dL, the LDL-C level is 125 mg/d, the HDL-C level is 32 mg/dL, and the triglyceride level is 170 mg/dL.

Case study 1 represents a primary cardiovascular disease (CVD) prevention patient classified as low risk by the Framingham Risk Score (FRS),[1] with 4% risk of myocardial infarction (MI) in 10 years. By ATP III guidelines for LDL-C management,[2] her goal LDL-C is < 130 mg/dL. Case study 2 represents a secondary CVD prevention patient classified as high risk (known coronary artery disease; CAD) with optimal goal LDL-C of < 70 mg/dL.[2] Both patients have been identified with cardiometabolic syndrome (CMS). What strategies will reduce their risk for atherosclerotic cardiovascular disease (ASCVD) and type 2 DM?

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