METABOLIC SYNDROME REACHES EPIDEMIC LEVEL

Metabolic syndrome, a cluster of common metabolic disorders including obesity, pre-diabetes, abnormal lipid levels and high blood pressure, is now approaching epidemic proportions worldwide.  A new report* from independent market analyst Datamonitor (DTM.L) reveals that a total 115million individuals suffer from this syndrome in the US , Japan , France , Germany , Italy , Spain and the UK .  According to Datamonitor, this number is set to increase rapidly, fuelled by the rising obesity and diabetes epidemic. Significant though it is, the metabolic syndrome patient population remains poorly diagnosed and there are no drugs currently available to treat all components of metabolic syndrome. Lifestyle changes are recommended as first line therapy, however the proposed lifestyle counseling and support necessary may not always be directly applicable.  As such, there is urgent need for single pill combination therapy and drugs to treat multiple conditions that constitute metabolic syndrome.   

Metabolic syndrome: A ticking time bomb

Metabolic syndrome was first described in 1988 as the link between high blood pressure, Type II diabetes, unhealthy blood cholesterol, and problems that could lead to cardiovascular disease, premature coronary artery disease, stroke and peripheral vascular disease. Metabolic syndrome is now reaching epidemic levels. Up to one in four U.S. adults aged over 20 have such a cluster of risk factors1.

Physician awareness of metabolic syndrome has greatly grown over the years, but there still remains a gap in awareness between specialists and GPs. 

According to Datamonitor, this is, in part, due to the lack of consensus among the bodies involved in creating awareness about the condition, with regards to its definition and the guidelines that govern diagnosis and treatment.  In Datamonitor’s view, there is also need for a clear strong public health message to grow consumer awareness of the consequences of obesity and sedentary lifestyles.

Lifestyle changes alone are not enough

Treatment of metabolic syndrome has so far focused primarily on Therapeutic Lifestyle Changes (TLC) strategies.  Patients work with their physician to plan a diet enabling the loss of excess weight and maintenance of a healthy diet. The proposed strategy also includes increased level of physical activity and the lowering of blood pressure.

While TLC strategies have been shown to be effective in clinical trials, they are not the most practical to stick to in everyday life.  Failing to comply with the full regimen is not unusual and physicians feel they cannot supply the level of support and motivation that is given to patients in these trials. TLCs can also be expensive.  Indeed getting fitter and slimmer will lead to the purchasing sports equipment and possibly gym membership, and may require referral to a dietician.

Hope in pharmacological therapy

Existing therapies, for example statins, anti-obesity and anti-diabetics drugs, which could be used for the potential treatment of the condition are far from perfect.  The use of these drugs is associated with side effects (for example kidney damage and failure, dizziness, flushing and hypotension), inherent pill burden and the long-term safety of taking preventive medications will need to be proven. Furthermore, the size and diversity of the disease would make any attempt to target the entire metabolic syndrome market a difficult one.

These issues may be resolved by the growing trend in the use of single pill combination therapies and research into compounds, which target multiple conditions. Indeed, some of the most interesting drugs in development are dual peroxisome proliferator-activated receptors (PPARs), which have the potential to reduce the risk of both cardiovascular and diabetic complications. 

Two such compounds are currently in late-stage development AstraZeneca’s Galida (tesaglitazar) and Bristol-Myers Squibb’s muraglitazar are both undergoing Phase III clinical trials and results have shown that these drugs are able to control blood sugar, cut triglycerides lower LDL cholesterol and increase HDL cholesterol. If clinical trials are successful, these drugs could be available in the next two to three years.

Laurent Chanroux, Associate Analyst and author of the report comments:

“The rapidly increasing prevalence of the condition will require a concerted effort from all stakeholders involved, including national medical organisations, pharmaceutical companies, insurance companies and governmental agencies, to continue the educational efforts already put in place and develop a much-needed consensus definition for diagnosis.  This is turn will allow government agencies to promote the importance of the condition and its treatment to GPs and the general public.”   

1 the third National Health and Nutrition Examination Survey’. JAMA 2002, 287(3): 356-9

  (8/7/04)