The Metabolic Syndrome (MS) is a clustering of metabolic alterations including central obesity, hypertension, dyslipidaemia and hyperglycaemia. It carries increased risk of diabetes and long term cardiovascular disease (CVD), although short - term CV risk is better predicted by other means. Insulin resistance (IR) is a major underlying factor in the MS, with profound implications in terms of metabolic and CV morbidity.
Causes of IR are complex: altered adipose tissue endocrine functions, altered lipid metabolism also in non-adipose tissues, inflammation and oxidative stress are emerging as the key players. Important roles are also attributable to altered nutrient sensing in the gut and CNS. Measurement of IR with reliable surrogates provides an important tool for effective management of metabolic and CV risk in MS patients. Regarding therapeutic approaches, lifestyle modification improves diabetes and CV risk and is the first step in the treatment of MS. Modest weight loss and light physical activity significantly reduce IR. However, behavioral strategies are necessary to achieve long term success in maintaining adequate food intake and exercise. Finally, drug therapy of MS should address each of its components to prevent diabetes and CV disease and to reduce overall mortality. Metabolic effects and safety profile of each drug should be carefully considered.