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Metabolic Syndrome
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Get a big picture look at metabolic syndrome in a printable PDF file entitled, Getting Tough with Metabolic Syndrome
The American Academy of Family Physicians is an excellent resource for information on metabolic syndrome, it components, and practical advice on prevention and treatment: "What is Metabolic Syndrome?" "What Does Diabetes Have to Do with Heart Disease?" "High Blood Pressure: Things You Can Do to Help Lower Yours" "Cholesterol: What Your Level Means" "Exercise: A Healthy Habit to Start and Keep"
The American Association for Clinical Chemistry partners with several other organizations to develop Lab Tests Online, a comprehensive list and description of lab tests that may be ordered by your doctor, whether it is for routine care or diagnostic purposes. Lab tests related to Metabolic Syndrome are discussed in detail.
The National Heart, Lung, and Blood Institute (NHLBI) web site provides information on diseases of the heart, blood vessels, lung, and blood. Metabolic Syndrome is listed in their directory of disorders because of its close association with heart and vascular disease.
Information on this site can help you increase your understanding of metabolic syndrome and its underlying causes.
The American Diabetes Association is dedicated to the prevention and cure of diabetes, as well as improving the lives of everyone affected by the disease. They strongly support scientific research into the causes and precursors of the disease, and act as advocates for diabetes patients and their families.
The Obesity Society is dedicated to the study and treatment of obesity. In addition to promoting research and advocating for change, its mission includes keeping the medical community and public informed of new advances.
The American Society of Hypertension, Inc (ASH) was founded in 1985 as a Society dedicated to clinical and basic research, and education in hypertension, related cardiovascular disease and vascular health. Their site has an excellent section of resources titled "About Hypertension".
Episode number: 
208

About one in five American adults suffers from metabolic syndrome*, a preventable and reversible disorder that puts you at significant risk for heart disease, stroke, diabetes, and other medical problems. Sometimes referred to as insulin resistance syndrome and syndrome X, this condition can damage your body for years without giving you a clue that you have a problem.

Capable of affecting anyone at any age, metabolic syndrome is a group of cardiovascular risk factors that are linked to your body's metabolism (the name given to all the chemical processes that take place in your body). Usually linked to obesity, physical inactivity, and genetic factors, metabolic syndrome is characterized by a clustering of risk factors for heart disease that include:

  • Central obesity (excessive fat tissue in and around the abdomen)
  • Dyslipidemia (blood fat disorders – mainly high triglycerides and low HDL "good" cholesterol – that promote plaque buildups in artery walls)
  • Insulin resistance or glucose intolerance (problems with how your body uses insulin, resulting in too much glucose (sugar) in your blood
  • High blood pressure

If you have one component of metabolic syndrome, you are at increased risk for having one or more of the others.  And the more components you have, the greater your risk of developing major medical problems. Studies have shown that people who have metabolic syndrome are twice as likely to develop cardiovascular problems and four times as likely to develop type 2 diabetes as people who don't have metabolic syndrome.

 

Quick Facts

  • About 47 million U.S. adults have metabolic syndrome, a set of health risks that increase your chance of developing heart disease, stroke, and diabetes. The number of people with metabolic syndrome increases with age, affecting more than 40 percent of people in their 60s and 70s.
  • The underlying causes of metabolic syndrome are overweight/obesity, physical inactivity and genetic factors.
  • You are diagnosed with metabolic syndrome if you have three or more of the following risk factors: 
    • A waistline of 40 inches or more for men and 35 inches or more for women (measured across the belly) 
    • A blood pressure of 130/85 mm Hg or higher 
    • A triglyceride level above 150 mg/dl 
    • A fasting blood glucose (sugar) level greater than 100 mg/dl 
    • A high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women)
  • If you have all the components of  metabolic syndrome, you are six times as likely to develop heart disease as someone who has none of the risk factors.
  • Metabolic syndrome is closely associated with insulin resistance, a metabolic disorder which interferes with the body's ability to use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome.
  • According to the American Heart Association, three groups of people often have metabolic syndrome: 
    • People with diabetes who cannot maintain a proper level of glucose (glucose intolerance) 
    • People without diabetes who have high blood pressure and who also secrete large amounts of insulin (hyperinsulinemia) to maintain blood glucose levels 
    • Heart attack survivors who have hyperinsulinemia without glucose intolerance
  • Physical inactivity and excess weight are the main underlying contributors to the development metabolic syndrome. So getting more exercise and losing weight can help reduce or prevent the complications associated with the condition. Doctors may also prescribe medications to manage components of the disorder..
  • It's not inevitable that people who have metabolic syndrome will develop diabetes. Studies in the United States and abroad show that lifestyle changes, including weight loss, dietary modifications, and increased physical activity, can prevent or delay the onset of type 2 diabetes among high-risk adults.
  • Improved control of cholesterol and lipids can reduce cardiovascular complications by 20% to 50%.
  • Blood pressure control can reduce the risk of heart disease and stroke by approximately 33% to 50%.

*Quick Facts have been reviewed by Medical Advisors and are current as of October 2005.

Ask Your Doctor

This list questions will provide a good starting point for a discussion with your doctor.  However, it is not a complete list.

General

  • What exactly is metabolic syndrome?
  • What are the health risks associated with metabolic syndrome?
  • Am I at risk for metabolic syndrome?
  • How do I know if I have it?  What are the symptoms?
  • Are there tests for metabolic syndrome? 
  • What can I do to reduce my risk of metabolic syndrome?
  • If I have metabolic syndrome, what can I do about it?
  • What are my treatment options?
  • How will we determine if the treatment is working?
  • If I have metabolic syndrome, are others in my family at risk?

Heart Disease, Stroke, Diabetes

  • What are my risk factors for heart disease?
  • Am I at risk for stroke?
  • What are the warning signs of heart disease and stroke?
  • What kind of physical activity is right for me?
  • What is my blood pressure, and is it at a healthy level?
  • What is my blood cholesterol, and is it at a healthy level?
  • What can I do to lower my risk of heart disease and stroke?
  • What is insulin resistance and how does that affect my risk for heart disease?
  • Am I at risk for developing diabetes?
  • What can I do to prevent diabetes?

Weight Control, Diet, and Physical Activity

  • Do I need to lose weight?
  • What is the best way for me to lose weight?
  • How much weight should I lose, and how fast? What's a realistic goal for me?
  • What diet guidelines should I follow?
  • What should my daily calorie, fat and cholesterol intake be?
  • Do I need to see a nutritionist or dietitian? If so, can you recommend one?
  • Do I need to exercise to lose weight?
  • What are the best types of activities for me?
  • How much activity do I need to do?
  • Once I lose the weight, how do I keep it off?

Cholesterol

  • What do my cholesterol numbers mean?
  • How often should I have my levels checked?
  • How does physical activity affect my levels?
  • What type of diet should I eat?
  • Will I need cholesterol-lowering medicine?
  • How long will it take to reach my cholesterol goals?

High Blood Pressure

  • What should my blood pressure be?
  • How often should my blood pressure be checked?
  • What about home blood pressure monitors?
  • Should I use blood pressure machines at stores?
  • How does physical activity affect my blood pressure?
  • What's my daily sodium (or salt) limit?

Medications

  • Will you prescribe one or more medications as part of my treatment?
  • What is the medicine supposed to do?
  • How and when do I take it, and for how long?
  • What foods, drinks, other medicines or activities should I avoid while taking this medicine?
  • What are the possible side effects and what should I do if they occur?
  • Is there any written information available about the medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of not taking this medication?

Smoking

  • What effects does smoking have on metabolic syndrome?
  • What can I do to stop the cravings? When will they stop?
  • Will a nicotine patch or gum help?
  • Can I take a smoking cessation medication?
  • What if I slip and go back to tobacco?
  • How long will it take to reduce my risk?

Key Point 1

Most people who have metabolic syndrome are completely unaware.  It is a cluster of disorders with your body's metabolism, each of these disorders is by itself a risk factor for other diseases.  In combination, they dramatically boost your chance for developing life-threatening illnesses.

Information about metabolic syndrome is just starting to show up in the popular press, even though doctors have debated its existence for years.  Today, most medical professionals accept the syndrome, not as a disease but rather as a cluster of risk factors.  Still, metabolic syndrome is under recognized and most of the over 40 million Americans with it remain undiagnosed.

Each one of the conditions involved in metabolic syndrome is a risk factor for other diseases. When they come together, they can dramatically multiply your risk of developing heart disease, stroke, and type 2 diabetes.  If you have all the components of metabolic syndrome, you are six times as likely to get heart disease than someone who has none of the risk factors.

Here's a look at the key medical disorders that come together in metabolic syndrome:

  • Central obesity. The location of body fat is important. If fat accumulates mostly around your stomach (central obesity is sometimes called apple-shaped obesity), you are at greater risk for type 2 diabetes, high blood pressure, high cholesterol, and cardiovascular disease than people who are lean or people with fat around the hips (called peripheral or pear-shaped obesity). Obesity is linked to 280,000 deaths in the United States each year, making it second only to cigarette smoking as a cause of death.
  • Hypertriglyceridemia.  If you have very high levels of triglycerides in your blood, you have hypertriglyceridemia and are at increased risk of developing heart disease. Triglycerides are a group of fatty compounds that circulate in the bloodstream and are stored in your fat tissue. Very high triglycerides can cause health problems including pancreatitis and enlarged liver and spleen. High-fat foods, weight gain, and aging are some of the things that cause high triglyceride concentrations in the blood.
  • Low HDL cholesterol.  Cholesterol is a type of fat that is needed for many bodily functions, such as the production of hormones. It comes from food sources and is also manufactured in your body by the liver. There are two forms of blood cholesterol. Low density lipoprotein (LDL) cholesterol is known as the 'bad' cholesterol because it contributes to heart disease by sticking to and narrowing blood vessels. High density lipoprotein (HDL) cholesterol is known as the 'good' cholesterol because it keeps LDL levels in check and helps protect against heart disease. The opposite is also true: low levels of HDL cholesterol increase the risk of heart attack.
  • Hypertension, or elevated blood pressure, indicates that the heart is working harder than normal, putting both the heart and the arteries under a greater strain. This may contribute to heart attacks, strokes, kidney failure and atherosclerosis. If high blood pressure isn't treated, the heart may have to work progressively harder to pump enough blood and oxygen to the body's organs and tissues to meet their needs.
  • Fasting hyperglycemia is when blood glucose stays above a desirable level after you have not eaten for at least eight hours. It occurs when the body does not have enough insulin or cannot use the insulin it has to turn glucose into energy. This condition can signal the start of type 2 diabetes, a disease that can increase your risk for a heart attack or stroke, as well as damage your eyes, nerves or kidneys.
    

Key Point 2

Just because you haven't heard of metabolic syndrome doesn't mean it is not important.  It is the "perfect storm" of risk factors.

When you have metabolic syndrome, your body goes through a series of biochemical changes which, over time, can lead to the development of one or more interrelated medical conditions. Think of it as a metabolic chain-reaction that begins when insulin, a hormone excreted from your pancreas, loses its ability to make your cells absorb glucose (sugar) from the blood. When this happens, your glucose levels remain elevated for an abnormally long time after you eat. Your pancreas, sensing a high glucose level in your blood, continues to produce insulin.

Consistently high levels of insulin and glucose in your blood can bring about a number of harmful changes in your body, including:

  • Damage to the lining of coronary and other arteries, a key step toward the development of heart disease and stroke.
  • Changes in your kidneys' ability to remove salt, which can lead to high blood pressure, heart disease, and stroke.
  • An increase in triglyceride levels, which increases your risk of developing cardiovascular disease.
  • An increased risk of blood clot formation, which can block your arteries and cause heart attacks and strokes.
  • A slowing of insulin production, which can signal the start of type 2 diabetes, a disease that can increase your risk for heart attack, stroke and other serious conditions associated with diabetes.

Doctors generally diagnose metabolic syndrome with a physical exam, medical history, and blood tests (using criteria outlined by the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program) to identify specific risk factors. Patients with three or more risk factors are usually diagnosed with metabolic syndrome.

 

Criteria for diagnosing metabolic syndrome
Risk factorDefining level
Central abdominal obesity (waist circumference)Men: Greater than 40 in. (101.6 cm)
Women: Greater than 35 in. (88.9 cm)
Hypertriglyceridemia (high triglycerides)Greater than 149 mg/dL
Low HDL ("good") cholesterolMen: Less than 40 mg/dL
Woman: Less than 50 mg/dL
Hypertension (high blood pressure)Greater than 129/84 mm Hg
Fasting hyperglycemia (elevated fasting glucose/blood sugar)Greater than 109 mg/dL
Based on guidelines set forth by the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).

There are many other variables that may influence a diagnosis, including:

  • Age. The incidence of metabolic syndrome increases with age.
  • Personal or family history of heart disease, high blood pressure, or diabetes. (There is a greater risk for metabolic syndrome for those who have experienced diabetes during pregnancy (gestational diabetes) or who have a family member with type 2 diabetes
  • High-fat diet
  • Sedentary lifestyle
  • Smoking
  • History of heavy drinking
  • Ethnicity - African Americans and Mexican Americans are more prone to metabolic syndrome. African-American women are about 60 percent more likely than African-American men to have the syndrome.
    

Key Point 3

If you've been diagnosed as having metabolic syndrome, it is not too late.  If you can exercise and lose the weight, you can beat the rap.  And drug therapy will be a part of your treatment.  Metabolic syndrome can be treated and reversed, even prevented...and you can live longer.

Metabolic syndrome is preventable and many of its risk factors are reversible. In some cases, medicines are given to treat metabolic syndrome, but it's likely that your doctor will first want you to try to make lifestyle changes – including weight loss, increased physical activity, and dietary modifications – to reduce your risk factors.

Central body fat
Studies of overweight, sedentary adults have found that those who start to exercise can lose, or at least not add to, their stores of abdominal fat.  Even moderate exercise, such as brisk walking, can help.  In fact, amount of exercise matters more than intensity of exercise.  So, if you walk briskly 5 hours a week, you'll do better than someone who participates in more vigorous exercise for a couple of hours a week. 

Exercise is half the equation -- making wise food choices is the other:

  • By making wise food choices, you can help control your body weight, blood pressure and cholesterol.
  • Consider the serving sizes you eat. Reduce serving sizes of foods high in fat and increase the amount of fruits and vegetables you consume.
  • Limit your fat intake to about 25 percent of your total calories. Your doctor or a dietitian can help you figure how much fat you need to eat.
  • Keep a food and exercise log. By writing this down, you are more likely to stay on track.
  • When you meet your goal, reward yourself with a nonfood item or activity.

Diabetes
There's a lot you can do to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing weight can all help. Lowering blood pressure and cholesterol levels can also promote better health. Your doctor, a dietitian, or a nutrition or fitness counselor can help you make a plan. Here are some of the areas to consider in reducing your risk of diabetes.

Reach and maintain a reasonable body weight
Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. Losing even a few pounds can help reduce your risk of developing Type 2 diabetes. One way to determine if you are overweight is by checking your BMI (Body Mass Index), a weight to height ratio. See the following link to determine your BMI: http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.pdf

Be physically active every day
Exercise for at least 30 minutes a day, 5 days a week. If you're not a very active person now, start slowly. And talk with your doctor about the kinds of exercise that are safe for you.

Control diabetes with drugs
In some people, blood glucose levels can be successfully controlled with diet and exercise, but many people require insulin or drugs designed to overcome the body's
resistance to insulin.  

Dyslipidemia
Dyslipidemia is a blood fat disorder that increases the risk for heart disease.  It occurs when the amounts of lipids in the blood (e.g. LDL cholesterol, HDL cholesterol, and triglycerides) are higher or lower than normal.

It's estimated that a 1% reduction in LDL cholesterol is equivalent to a 1% reduction in risk for cardiovascular disease. So a treatment option that safely reduces LDL levels is an important component in battling elevated total and LDL cholesterol levels.

There are two basic ways to manage dyslipidemia. The first is to modify your lifestyle by changing your diet, managing your weight, increasing exercise, and quitting smoking. The other is to use one or more cholesterol-lowering medications while modifying your lifestyle. Both treatment methods are aimed at lowering LDL cholesterol, raising HDL cholesterol, lowering triglycerides, and reducing other risk factors for heart disease. Your doctor can help you determine the best course of action.

Statins, or cholesterol-lowering drugs, have been shown to be very effective in reducing LDL levels along with decreasing total cholesterol. They can also help to raise HDL cholesterol. The effectiveness of statins, along with their low incidence of serious side events and good tolerability, has made them the drug treatment of choice for managing dyslipidemia.

Tips for Dealing with Dyslipidemia

  • Watch what you eat. Limit your total fat intake to 25% to 35% of your total calories each day. Most of your calories (50% to 60%) should come from carbohydrates, such as bread, cereals, rice, and grains. The other 15% of your total daily calories should come from proteins, such as meat, fish, eggs, or beans.
  • Limit your intake of saturated fats to less than 7% of your total fat intake. Saturated fats, such as shortening, lard, or butter are solid at room temperature. Better sources of fat include vegetable, olive, and fish oils.
  • Cut back on margarine and butter. If you use them, the whipped types are lower in fat than the type that comes in sticks. Be sure to use any type only in small amounts.
  • Get moving. Do exercises that raise your heart rate such as walking, running, swimming, biking, or dancing. Work out for 30 to 45 minutes, 5 days a week. Be sure to talk with your doctor before starting a fitness program.
  • Don't smoke. If you smoke, stop. If you need help breaking the habit, ask your health care provider about techniques or treatments that can help you quit.
  • Limit your alcohol intake. If you are a woman or small man and drink alcohol, don't have more than one drink a day. If you're a medium- to large-sized man, don't have more than two drinks a day.
  • Eat 20 to 30 grams of soluble fiber every day. Foods such as bran, beans, and peas help lower your bad cholesterol (LDL).
  • Take your medicine. For many people, diet and exercise aren't enough; some people need drugs to help lower their cholesterol. You and your health care provider will decide which drug is right for you. You may need to take more than one type of medicine to get your cholesterol under control.

Medline Plus

Medline Description: 

Conduct an off-site search for Metabolic Syndrome information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second OpinionKey Points.

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