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.
Literatur
-
1
Kylin E.
Studien über das Hypertonie-Hyperglykämie-Hyperurikämiesyndrom.
Zentralblatt für Innere Medizin.
1923;
44
105-127
-
2
Mehnert H, Kuhlmann H.
Hypertonie und Diabetes mellitus.
Dtsch med J.
1968;
19
567-571
-
3
Hanefeld M, Leonhardt W.
Das metabolische Syndrom.
Dt Gesundh Wesen.
1981;
36
545-551
-
4
Reaven GM.
Banting lecture 1988. Role of insulin resistance in human disease.
Diabetes.
1988;
37
1595-1607
-
5
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
JAMA.
2001;
285
2486-2497
-
6 International Diabetes Federation .The IDF consensus worldwide definition of the metabolic syndrome [article online]. Available at www.idf.org
-
7
Katzmarzyk PT, Janssen I, Ross R. et al. .
The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men.
Diabetes Care.
2006;
29
404-409
-
8
Hu G, Qiao Q, Tuomilehto J. et al. .
Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.
Arch Intern Med.
2004;
164
1066-1076
-
9
Rathmann W, Haastert B, Icks A. et al. .
Prevalence of the metabolic syndrome in the elderly population according to IDF, WHO, and NCEP definitions and associations with C-reactive protein: The KORA Survey 2000.
Diabetes Care.
2006;
29
461
-
10
Kaplan N.
The deadly quartet: upper body obesity, glucose intolerance, hypertriglyceridemia, hypertension.
Arch Intern Med.
1989;
149
1514-1520
-
11
Meigs JB, Wilson PWF, Fox CS. et al. .
Body mass index, metabolic syndrome and risk of type 2 diabetes or cardiovascular disease.
J Clin Endocrin Metab: First published ahead of print May.
2006;
30
2006
-
12
Denke MA, Sempos CT, Grundy SM.
Excess body weight: an underrecognized contributor to high blood cholesterol levels in white american men.
Arch Intern Med.
1993;
153
1093-1103
-
13
Chan JM, Rimm EB, Colditz GA. et al. .
Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men.
Diabetes Care.
1994;
17
961-969
-
14
Mykkänen L, Kuusisto J, Pyörälä K, Laakso M.
Cardiovascular disease risk factors as predictors of Type 2 (non-insulin-dependent) diabetes mellitus in elderly subjects.
Diabetologia.
1993;
36
553-559
-
15
Heseker H.
An epidemiological study of food consumption habits in Germany: comparison with other western countries.
Mediographia.
1994;
16
7-10
-
16
Vague J.
The degree of masculine differentiation of obesities, a factor determining predisposition to diabetes, atherosclerosis, gout and uric calculous disease.
Am J Clin Nutr.
1956;
4
20-34
-
17
Isomaa B, Almgren P, Tuomi T. et al. .
Cardiovascular morbidity and mortality associated with the metabolic syndrome.
Diabetes Care.
2001;
24
683-689
-
18
Wilson PWF, D'Agostino RB, Parise H. et al. .
Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus.
Circulation.
2005;
112
3066-3072
-
19
Yusuf S, Hawken S, Ôunpuu S. INTERHEART study investigators. .
Obesity and the risk of myocardial infarction in 27000 participants from 52 countries: a case-control study.
Lancet.
2005;
366
1640-1649
-
20
Visscher TL, Seidell JC, Molarius A. et al. .
A comparison of body mass index, waist-hip ratio, and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study.
Int J Obes Relat Metab Disord.
2001;
25
1730-1735
-
21
Kuk L, Katzmarzyk PT, Nichaman MZ. et al. .
Visceral fat is an independent predictor of all-cause mortality in men.
Obesity.
2006;
14
336-341
-
22
Fujimoto WY, Bergstrom RW, Boyko EJ. et al. .
Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study.
Diabetes Care.
1999;
22
1808-1812
-
23
Rexrode KM, Carey VJ, Hennekens CH. et al. .
Abdominal adiposity and coronary heart disease in women.
JAMA.
1998;
280
1843-1848
-
24
Lemieux I, Pascot A, Couillard C. et al. .
Hypertriglyceridemic Waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?.
Circulation.
2000;
102
179-184
-
25
Linnemann B, Voigt W, Nobel W, Janka HU.
C-reactive protein is a strong independent predictor of death in type 2 diabetes: association with multiple factes of the metabolic syndrome.
Exp Clin Endocrinol Diabetes.
2006;
114
127-134
-
26
Ford ES.
Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence.
Diabetes Care.
2005;
28
1769-1778
-
27
Sundstrom J, Riserus U, Byberg L. et al. .
Clinical value of the metabolic syndrome for long-term prediction of total and cardiovascular mortality: prospective population based cohort study.
BMJ.
2006;
332
878-882
-
28
Kahn R, Buse J, Ferrannini E, Stern M.
The Metabolic Syndrome: Time for a critical appraisal.
Diabetes Care.
2005;
28
2289-2304
-
29
Ingelsson E, Ärnlöv J, Lind L, Sundström J.
The metabolic syndrome and risk for heart failure in middle-aged men.
Heart.
2006;
-
30
Nicklas BJ, Cesari M, Penninx BW. et al. .
Abdominal obesity is an independent risk factor for chronic heart failure in older people.
J Am Geriatr Soc.
2006;
54
413-420
Anschrift des Verfassers
Prof. Dr. med. Hans Uwe Janka
Klinikum Bremen-Nord, II. Medizinische Abteilung
Hammersbecker Str. 228
28755 Bremen
eMail: Hans.Janka@klinikum-bremen-nord.de
