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Dyslipidemia. The characteristic abnormality of lipoprotein metabolism S

in patients with syndrome X is hypertriglyceridemia, usually associated with a low-HDL cholesterol concentration, increased postprandial lipemia, and small, dense LDL particles. The use of fibric acid derivatives in patients with syndrome X will significantly lower plasma TG concentrations, as well as improve all of J

the abnormalities associated with hypertriglyceridemia. In addition, there is now

& u evidence that the use of this class of drugs will decrease CHD risk in patients with the dyslipidemia associated with syndrome X.

Hypertension. Approximately 50% of patients with syndrome X have high blood pressure, and, as discussed previously, the risk of CHD is greatly increased in individuals when high blood pressure is one of the manifestations of syndrome X. Consequently, attention should be given to the choice of antihy-pertensive drugs in these individuals. Specifically, it seems reasonable to avoid the use of antihypertensive agents that will accentuate insulin resistance and/or its manifestations. However, it should be noted that low-dose thiazide diuretic therapy (12.5 mg of hydrochlorthiazide) is effective in lowering blood pressure, without untoward side effects on glucose or lipid metabolism, and that use of Preceptor antagonists is indicated in patients with a history of prior myocardial infarction.

Hypercholesterolemia. Although a high-LDL cholesterol concentration is not part of syndrome X, patients can have combined dyslipidemia (a high-TG and low-HDL concentration plus a high-LDL cholesterol concentration). These individuals are most at risk for CHD. As such, the need to lower LDL cholesterol concentration should not be ignored, and treatment with HMG CoA reductase inhibitors should be initiated if diet alone does not control LDL cholesterol concentrations in patients with syndrome X.

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