Metabolisch-Vaskuläres Syndrom - Diagnostische Strategien und Risikostratifizierung

Das Metabolisch-Vaskuläre Syndrom (MVS) ist das Auftreten verschiedener Risikofaktoren in einem Cluster. Jede einzelne Erkrankung erhöht schon per se das kardiovaskuläre Risiko, das gemeinsame Auftreten der Erkrankungen des MVS führt aber zu einer massiven Erhöhung des Risikos. Im Rahmen der Diagnostik des MVS ist der Taillenumfang zur Erfassung einer abdominalen Adipositas zu bestimmen. Weiter sind die Triglyzeride, das HDL-Cholesterin, die Nüchternplasmaglukose und ggf. der Blutzuckerwert nach 120 Minuten im 75g-oralen Glukosetoleranztest sowie der Blutdruck zu messen. Beeinflussbare Risikofaktoren sind neben der abdominalen Adipositas und der Fehlernährung erhöhte Blutzucker- und Lipidparameter, der Bluthochdruck, das Rauchen und eine zu geringe körperliche Aktivität. Nicht beeinflussbar sind genetische Faktoren, Alter und Geschlecht, sie bestimmen aber das kardiovaskuläre Risiko eines Patienten mit. Bei jedem Patienten ist das Risiko, z. B. mittels des PROCAM-Scores, individuell festzulegen, denn das Risiko bestimmt die Therapieziele: je höher das Risiko, umso stärker sind die Risikofaktoren abzusenken bzw. ist das HDL-Cholesterin zu erhöhen. Für die Diagnostik des MVS werden die Adult Treatment Panel III-(ATP III)-Empfehlungen des National Cholesterol Education Program der USA zugrunde gelegt (ATP III NCEP 2002)[2].

The Metabolic Vascular Syndrome (MVS) represents the occurrence of various risk factors in a cluster. Whereas every individual disease as such already increases the cardiovascular risk, risks are massively increased by the combined occurrence of the MVS diseases. When diagnosing MVS it is essential to measure the waist circumference to determine the extent of abdominal adiposity. Furthermore, it is essential to measure the triglyceride values, HDL cholesterol, plasma glucose on an empty stomach, and if necessary the blood sugar value after 120 minutes in the 75g oral glucose tolerance test, as well as the blood pressure. Risk factors that can be subject to treatment are, besides abdominal adiposity and wrong diet, increased blood sugar levels and lipid parameters: high blood pressure, smoking and excessive lack of activity. Among the risk factors beyond control are, for example, genetic factors, age and sex, although these factors participate in determining the patient's cardiovascular risk. It will be necessary to individually determine the risk of every patient, for instance by means of the PROCAM scores, for the individual risk determines the therapeutic goals: the higher the risk, the more the risk factors must be lowered or the HDL cholesterol must be increased. MVS diagnostics should be based on the recommen-dations by the Adult Treatment Panel III-(ATP III) of the National Choleste-rol Education Program of the United States of America (ATP III NCEP 2002)[2].

Key words

Metabolic vascular Syndrome -abdominal adiposity - waist circumference - PROCAM-Score - ATP III NCEP

Literatur

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