A Follow Up Study On Comprehensive Intervention Of Risk Factors In Metabolic Syndrome

Background and objective: Metabolic syndrome(MS) is characterized by a clustering of multiple of cardiovascular(CVD) risk factors, such as diabetes mellitus, impaired glucose tolerance, essential hypertension, central obesity, hypertriglyceridemia and low high-density lipoprotein cholesterol. Every composition of MS could raise the risk of cardiovascular complications, and the clustering of many risk factors would be more susceptible to the cardiovascular complications. Epidemiological studies have shown that the prevalence of MS and its cardiovascular complications have been increasing recently. How to take effective measures to prevent and treat MS is a urgent problem at present.The study aims to investigate the damage of the conduit vessels in MS and examine whether patients with MS modify their lifestyle and improve the achievement rate of the treatment guidelines according to the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP-ATPIII) after they received health care education during their hospitalization. Subjects and Methods 1. Subjects The follow-up study was conducted in 330 patients who admitted to hospital by initial diagnoses of type 2 diabetes mellitus(T2DM), hypertension(EH) and metabolic sydrome(MS). The average age of the follow-up patients was 59, Period of follow up is over 6 month to 3 year (mean follow up period 9 month) and 96.9% of follow-up rate. Peripheral arteriosclerotic occlusive disease( PAOD) criteria was defined by ABPI. Effectiveness of intervention was evaluated by comprehensive intervention of risk factors in metabolic syndrome and after intervention in 199 patients and comparison with a non-intervention group in 153 paients. We classified subjects with MS by NCEP-ATP III criteria according to the following schema: three or more of the following:1) BP ≥130/85 mmHg; 2)FPG ≥6.1 mmol/L; 3) fasting TG ≥1.69 mmol/L; 4) fasting HDL-C <1.04 or <1.29 mmol for male or female respectively; 5) waist circumference (Asian WHO criteria) >80 or 90 cm for female or male, respectively. T2DM was defined according to the American Diabetes Association(ADA). EH was defined as blood pressure levels ≥140/90 mmHg or the use of antihypertensive medication (WHO/ISH 1999). 2. Methods Age, sex, height, body weight, body mass index(BMI), waist circumference(WC), systolic and diastolic blood pressure were recorded. Waist circumference was taken midway between the inferior margin of the last rib and the crest of the ilium in the horizontal plane whilst in an upright position. Serum glucose, total cholesterol, triglyceride, HDL-Cholesterol and LDL-Cholesterol concentrations were determined after a 10-h fast. Lifestyle modification, dietary intake, education and practices were investigated by means of a structured questionnaire in patients with MS. Biochemical parameters were also analyzed. Some Patients measured ABPI by the Dopplex Assist . Results 1. Results of follow up study (1)Compared with before follow up, the control rate of salt restriction, the increase of regular exercise, reducing high-fat diet, drinking more milk production, reducing carbohydrate, food fiber intake, stop drinking, medicine taken were significantly increased. But,smoking given up was not significantly improved, especislly in male patients. (2)Compared with before follow up, the level of blood pressure,TG,fasting glucose,BMI and LDL-C were significantly decreased, the level of HDL-C was significantly higher, the level of waist circumference and weight were not significantly improved. (3)The control rate of TG,HDL-C,LDL-C and fasting glucose in patients were significantly increased. But, the control rate of and waist circumsference were not significantly changed. According to NCEP-ATPⅢdefinition,the control rate of contractive blood pressure were not significantly increased, but According to NCEP-ATPⅢdefinition, blood pressure were significantly increased. (4)Compared with before follow up, the level of BMI,TG and waist circumference were significantly higher in MS compared with T2DM and EH, the level of contractive pressure and weight were significantly higher in MS compared with T2DM. Among the five ingredients of MS, the uncontrol was rare, and the complete control was rare too. It is common that 2-4 ingredients were uncontrol. 2.Comprehensive intervention of PAOD(1)The incidence rate of PAOD in MS was significantly higher than. EH and T2DM group(38.9%vs14.3%,P<0.05); (2)Patients of angiostegnosis had higher FPG,TG,WC and SBP;the angiosteosis patients had higher FPG,TG,WC and SBP; (3)Compared with non-intervention group, the intervention group had lower BMI,LDL-C,DBP and FPG and higher HDL-C; The incidence rate of PAOD in intervention group was significantly lower than non-intervention group(P<0.05); (4)The rate of PAOD in smoking patients was significantly hingher than no smoking patients(26.9%vs51.2%,P<0.05)and lower in patients with regular exercise(66.0% vs 22.0%,P<0.05);The rate of PAOD was significantly lower in patients with regular medicine taken than refuse to overdose(66.0% vs 22.0%,P<0.05)。Conclusion 1. Through the health education and the regular follow up, some of the lifestyles, the control rate of medicine taken and self-monitoring in patients were obviously improved, but the curative effects of the intervention on each components of MS was different, smoking and obesity was related to life style also; 2. The incidence rate of PAOD in MS was significantly higher than EH and T2DM group , the incidence of PAOD was related to metabolic disorders; 3. The comprehension intervention of the risk factors of MS can give protection to MS and limb vasculopathy.