Treating Arterial Stiffness Associated with Features of Metabolic Syndrome Not Included in its Diagnostic Criteria: Cutting Off the Heads of Lernaean Hydra, Keeper of the Underworld

The clustering of cardio-metabolic risk factors, regardless if this is called metabolic syndrome (MetS) or not, substantially increases the risk of cardiovascular disease (CVD) and all-cause mortality. One of the possible mechanisms of the rise in CVD incidence is the increase in arterial stiffness (AS), which is a significant and independent CVD risk factor. Hypertension has long been connected to AS. Besides MetS components (obesity, dyslipidaemia, hypertension, dysglycaemia), MetS-associated disease states, not included in the MetS diagnostic criteria (renal dysfunction, hyperuricaemia, non alcoholic fatty liver disease, obstructive sleep apnea, polycystic ovary syndrome and hypercoaglutability) have been implicated in the increase of CVD risk through the increase of AS, among other mechanisms. Treatment options for AS induced by these non-diagnostic features of MetS are discussed. The impact of lifestyle changes is analyzed. Among pharmacological interventions, statin treatment seams to hold a pivotal role. Furthermore, we discuss specific measures for each disease state separately.