Syndrome métabolique : diagnostic, conséquences cardiaques et vasculaires

Abstract

The world medical community and the cardiologists are gaining awareness of the increasing danger of metabolic syndrome. Its prevalence varies widely according to the studies, with and incidence of 16 % in men and 11 % in women in France for the DESIR study. The major abnormality seems to be the increase of central fat, that is responsible for an increase of free fatty acids delivered to the liver, and an insulin resistance. Those two abnormalities are then going to induce a cascade of abnormalities dealing with numerous atheromatous risk factors. Then will appear high triglycerides, a low HDL, small dense LDL, an increase of blood pressure, a shift of coagulation parameters toward a pro-thrombotic state, an insulin resistance, an increase of CRP, an activation of cytokines and adhesines, an endothelial dysfunction, an oxydative stress. The metablic syndrome has two major complications, the cardio-vascular complications that are increased by a factor of 2 to 3, and the risk of evolution toward non insulin dependant diabetes who will by itself increase the cardio-vascular risk, with depending of the studies a relative risk of evolution toward NIDDM of 10 when the metabolic syndrome is present. The major interest remains however to isolate the high risk patients in the population, who are the most concerned by the prevention measures.