Godine 1967. Crepaldi je prvi zapazio da se u mnogo ljudi istovremeno pojavljuju pretilost, dislipidemija, šećerna bolest i hipertenzija. Kasnih sedamdesetih godina dvadesetog stoljeća njemački su istraživači takvo nakupljanje stanja nazvali metaboličkim sindromom. Otada je taj sindrom opisivan pod nekoliko naziva kao "sindrom inzulinske rezistencije", "sindrom X", "plurimetabolički sindrom", te "metabolički sindrom". Sindrom zapravo predstavlja višekomponentnu bolest nastalu kombinacijom načina življenja i čimbenika okoline, s time da su neke populacije pokazale genetičku podložnost za razvoj tog sindroma. Metabolički sindrom povećava rizik za kardiovaskularnu bolest i šećernu bolest tipa 2. Nacionalni program obrazovanja o kolesterolu -Panel liječenja odraslih III (engl. National Cholesterol Education Program -Adult Treatment Panel III, NCEP-ATP III) prepoznao je metabolički sindrom kao skup abnormalnih stanja koja povećavaju rizik, kako za kardiovaskularnu bolest (KVB), tako i za šećernu bolest tipa 2. Smjernice NCEP-ATP III također su istaknule središnju ulogu abdominalne pretilosti u razvoju tog sindroma. Rastuća prevalencija sindroma ima važne zdravstvene implikacije. Svaka sastavnica metaboličkog sindroma predstavlja potvrđeni čimbenik rizika za KVB, no prisutnost mnogih komponenti rezultira većim rizikom nego zbroj rizika povezanih s pojedinačnim komponentama. Dokazano je, primjerice, da su muškarci s istodobnom prisutnošću hiperinzulinemije nakon gladovanja, s povišenim koncentracijama apolipoproteina B, te povišenim udjelom malih LDL-čestica imali 20 puta veći rizik razvijanja KVB tijekom petogodišnjeg razdoblja praćenja u studiji, nego muškarci bez tog skupa netradicionalnih biljega rizika. Usto, rizik za KVB povezan s tom aterogenom metaboličkom trojkom ostao je značajan čak i nakon prilagodbe za tradicionalne rizične čimbenike kao što su koncentracije LDL-kolesterola, triglicerida i HDL-kolesterola. Procjena rizika uključuje listu bioloških parametara u kojoj važnu ulogu imaju lipidi, posebice trigliceridi i HDL-čestice. Tradicionalni čimbenici povezani s metaboličkim sindromom su pretilost, inzulinska rezistencija, hiperglikemija, dislipemija, hipertenzija i mikroalbuminurija.
The serum concentrations of total cholesterol (TC), triglycerides (RG), high density lipoprotein-cholesterol (HDLc), low density lipoprotein-cholesterol (LDLc), and the apolipoproteins (apo) A-I, A-II, and B were measured in 33 hyperthyroid patients before and after treatment. The results were compared with those of healthy controls. Apo A-I, A-II, and B were assayed by immunonephelometry. The serum levels of TC (mean +/- SD, 167 +/- 36 mg/dl, HDLc (40.8 +/- 12 mg/dl), and LDLc (108 +/- 35 mg/dl) were decreased in the untreated hyperthyroid patients compared to both the values after treatment (TC: 215 +/- 54 mg/dl; P less than 0.001; HDLc: 52 +/- 14 mg/dl; P less than 0.001; LDLc: 146 +/- 47 mg/dl; P less than 0.001) and the control values (TC: 206 + 39 mg/dl; P less than 0.001; HDLc: 47.4 +/- 10 mg/dl; P les than 0.01; LDLc: 145 +/- 38 mg/dl; P less than 0.001). TG levels were not statistically different before and after treatment. The apo A-I concentrations (116 +/- 24 mg/dl) were lower before than after treatment (131 +/- 28 mg/dl; P less than 0.01), but they were not statistically different from those in the control group (115 +/- 19 mg/dl). The apo A-II levels were identical in all groups (before treatment, 35 +/- 7 mg/dl; after treatment, 37 +/- 9 mg/dl; control group, 36 +/- 9 mg/dl). The apo B levels were lower in the untreated hyperthyroid patients (86 +/- 23 mg/dl) compared to those in controls (103 +/- 19 mg/dl; P less than 0.001) and patients after therapy (103 +/- 25 mg/dl; P less than 0.001). The increase in HDLc relative to the major HDL apo A-I and A-II during treatment for hyperthyroidism was associated with changes in body weight. The apo A-I to apo A-II and LDLc to apo B ratios, however, were significantly lower before compared to those after treatment, when the influence of increasing body weight during therapy was accounted for. This study emphasizes the important regulating role of thyroid hormones on lipid and apolipoprotein metabolism.
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