Obesity
For weight loss, there are 2 main drug groups: appetite suppressants and absorption inhibitors (Kasper 2015).
The appetite suppressants include, for example, sibutramine (trade name Reductil). On average, a weight reduction of 4.5 kg per year can be achieved with it (Biesalski 2010).
These drugs inhibit the absorption of dietary fats in the gastrointestinal tract. Examples include orlistat (trade name Xenical). This can reduce fat absorption by up to 30% (Biesalski 2010).
LDL cholesterol
Patients should follow a rigorous diet low in saturated fat, trans fat and cholesterol. If this does not lower LDL cholesterol, therapy with statins such as atorvastatin or rosuvastatin is indicated.
Statins lower LDL cholesterol by about 15-60%, but each doubling of the statin dose only lowers it by about another 6%.
For patients with a 10-year risk of < 7.5%, statin therapy is not evidence-based (Kasper 2015).
Triglycerides
Fasting triglyceride levels should be < 150 mg / dl. From a weight reduction of > 10%, a reduction in triglycerides is possible. If weight loss alone does not lead to the target value, treatment with a fibrate such as gemfibrozil or fenofibrate is required (Kasper 2015).
Arterial hypertension
All patients with MetS plus arterial hypertension should be recommended dietary measures such as a low-sodium diet high in vegetables and fruits, low-fat dairy products, and whole grains.
In patients with metabolic syndrome without diabetes, ACE inhibitors or angiotensin II receptor blockers are the first-line therapy, as these two groups of drugs appear to reduce the likelihood of developing type 2 DM (Kasper 2015).
Otherwise, see therapy of arterial hypertension.