Metabolic syndrome (also known as metabolic syndrome X) is a grouping of cardiac risk factors that result from insulin resistance (when the body's tissues do not respond normally to insulin). A person with metabolic syndrome has a greatly increased risk of developing type 2 diabetes, cardiovascular disease and premature death. In fact, another name for metabolic syndrome is pre-diabetes.
The risk factors seen in metabolic syndrome include: insulin resistance, obesity (especially abdominal obesity), high blood pressure, abnormalities in blood clotting, and lipid abnormalities. Specifically, metabolic syndrome is diagnosed if any three of the following are present:
- Elevated waist circumference: 40 inches or more for men; 35 inches or more for women
- Elevated triglycerides: 150 mg/dL or higher
- Reduced HDL (“good”) cholesterol: less than 40 mg/dL in men; less than 50 mg/dL in women
- Elevated blood pressure: 130/85 mm Hg or higher
- Elevated fasting glucose: 100 mg/dL or higher
Why Are These Risk Factors Grouped Together in Metabolic Syndrome?The primary problem in metabolic syndrome is insulin resistance. In the body's attempt to compensate for insulin resistance, extra insulin is produced, leading to elevated insulin levels. The elevated insulin levels can lead, directly or indirectly, to the characteristic metabolic abnormalities seen in these patients. Frequently, the insulin resistance will progress to overt type 2 diabetes, which further increases the risk of cardiovascular complications.
Who Gets Metabolic Syndrome?Metabolic syndrome tends to run in families, along with the propensity for type 2 diabetes. Metabolic syndrome will occur in susceptible people who become overweight and sedentary. So, metabolic syndrome (like type 2 diabetes) can most often be prevented with exercise and maintaining a healthy body weight.
Anyone with a family history of type 2 diabetes who is overweight and sedentary should be evaluated for metabolic syndrome.
Treatment of Metabolic Syndrome
Treating the Insulin Resistance
While there are drugs that improve insulin resistance, the use of these drugs is currently limited to people who have overt diabetes - studies have not established their usefulness in metabolic syndrome. Still, there is a way for people with metabolic syndrome to reverse their insulin resistance -- diet and exercise.
Anyone with metabolic syndrome should make every attempt to reduce their body weight to within 20% of their "ideal" body weight (calculated for age and height), and to incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle. With vigorous efforts to reduce weight and increase exercise, metabolic syndrome can be reversed, and the risk for cardiovascular complications can be substantially improved.
However, human nature (and human metabolism) being what it is, many individuals with metabolic syndrome have trouble accomplishing these goals. In these cases, each associated risk factor needs to be treated individually and aggressively.
Treating Lipid Abnormalities
While the lipid abnormalities seen with metabolic syndrome (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise, drug therapy is often required. Treatment should be aimed primarily at reducing LDL levels according to specific recommendations. Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made. Successful drug treatment usually requires treatment with a statin, a fibrate drug, or a combination of a statin with either niacin or a fibrate.
Treating the Clotting Disorder
Patients with metabolic syndrome can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic syndrome should generally be placed on daily aspirin therapy to help prevent such clotting events. You should speak to a doctor, of course, before starting any new medication regimen.
Treating the Hypertension
High blood pressure is present in more than half the people with metabolic syndrome and, in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Adequate blood pressure treatment in these individuals can substantially improve their outcome.
The key to preventing and metabolic syndrome, however, remains diet and exercise. Any person with a strong family history of metabolic syndrome or type 2 diabetes should be especially careful to maintain a healthy lifestyle.
Metabolic Syndrome. The American Heart Association. Available on-line at: http://www.americanheart.org/presenter.jhtml?identifier=4756
Metabolic Syndrome. National Heart Lung and Blood Institute. Available on-line at: http://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html