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Table 3 Metabolic syndrome and cardiovascular risk factors

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

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.
  - 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