Atherosclerotic cardiovascular disease in metabolic syndrome

This chapter focus on the impact on cardiovascular disease risk of Metabolic Syndrome as a whole and of its different components - single or in association. Single components of the MetS are independently associated with CV endpoints, and the risk of cardiovascular events increased with higher number of MetS components. There is an increased risk of mortality in those with MetS, even in the absence of established T2D. Endothelial dysfunction and accelerated atherogenesis due to dysglycemia, insulin resistance, metabolic dyslipidemia, chronic low-grade inflammation together with hemodynamic changes i.e. increases in heart rate, circulating blood volume, cardiac output, vascular resistance, and changes in myocardial metabolism, all contribute to CV burden. While MetS is not a very effective tool in predicting CV risk in short term, a thoughtful assessment of MetS may be useful for further interventions. The identification of the various stages in the evolution of MetS and of the subtypes of MetS based on the underlying pathophysiology allows to target for specific preventive and therapeutic management strategies. Lifestyle interventions represent the first-line therapies recommended for treatment of the metabolic syndrome.