Table 3 Metabolic syndrome and cardiovascular risk factors
Metabolic syndrome | Cardiovascular risk factors |
|---|---|
- insulin resistance | - family history of early-onset coronary heart disease: myocardial infarction or sudden death of the father or a first-degree male relative before the age of 55 or of the mother or a first-degree female relative before the age of 65 or stroke in a family member before the age of 45. |
- pro-thrombotic, inflammatory state | - on-going tobacco use or cessation within the last three years. |
- high blood pressure | - hypertension (even when treated). |
- changes in the distribution of adipose tissue | - HDL-cholesterol <0.4 g/L (NB: values >0.60 g/L are protective). |
- dyslipidemia characterized by hypertriglyceridemia (above 1.5 g/L) and low HDL cholesterol levels (<0.4 g/L in male and 0.5 g/L in female). leading to early-onset cardiovascular disease. | - Microalbuminuria >30 mg/24 h. |
| Â | - Age >50 in men, >60 in women + history of transplantation |
NB: Role of immunosuppressive regimen | |
- Glucocorticoid therapy increases total cholesterol, VLDL, the size and density of LDL particles and TG by increasing insulin resistance. | |
- Calcineurin inhibitors reduce clearance of athero- genic lipoproteins by increasing the activity of hepatic lipase and decreasing lipoprotein lipase. | |
- Ciclosporine, metabolized through CYP3A4, induces a greater adverse impact on lipid profiles than tacrolimus, and may increase systemic statin exposure | |
- Sirolimus causes dyslipidaemia in 50% of cases | |