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Metabolic Syndrome
(Syndrome X, Insulin Resistance Syndrome, Deadly Quartet)

Definition:
Metabolic syndrome is a group of risk factors of a metabolic origin that increase the risk of diabetes, coronary heart disease, stroke, and peripheral vascular disease. In general, it is characterized by:
  • Abdominal obesity
  • Dyslipidemia—high triglycerides and low high-density lipoprotein (HDL, or “good”) cholesterol
  • Elevated blood pressure
  • Insulin resistance
Causes:
Metabolic syndrome may be caused by:
  • Genetic factors
  • Insulin resistance
  • Dietary factors
  • Chronic low-grade inflammation
  • Aging
  • Lifestyle factors, such as:
    • Obesity
    • Lack of physical activity
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for metabolic syndrome include the following:

  • Overweight (especially excessive fat in the abdominal region)
  • Sedentary lifestyle
  • Age: Over 60 years old
  • Ethnicity: Latino/Hispanic American, African American, Native American, Asian American, Pacific Islander
  • Family history of type 2 diabetes, high blood pressure, or cardiovascular disease
  • History of glucose intolerance or gestational diabetes
  • A diagnosis of any of the following conditions:
    • High blood pressure
    • Elevated triglycerides/low HDL-cholesterol
    • Cardiovascular disease
    • Polycystic ovary syndrome
    • Acute pancreatitis
    • Chronic kidney disease
    • Gender
      • African American: female more than male by 57%
      • Mexican American: female more than male by 26%
Symptoms:
In general, metabolic syndrome causes no noticeable symptoms, except perhaps those related to obesity. The diseases that may result from metabolic syndrome, however, have symptoms, including symptoms of diabetes, heart disease, stroke, and poor leg circulation.

Diagnosis:
The doctor will ask about your medical history, perform a physical exam, and order laboratory tests.

Tests may include:

  • Blood tests to measure:
    • Fasting blood sugar levels (glucose) or a two-hour post-glucose challenge blood sugar level
    • Fasting insulin
    • Triglyceride level
    • HDL cholesterol level
  • Blood pressure
  • Calculation of body mass index (BMI) from weight and height

There are several criteria for diagnosing metabolic syndrome. You may be diagnosed with metabolic syndrome if you have at least three of the following measures:

  • Waist measurement--greater than 40 inches in Caucasian men (35 inches in Asian men) or 35 inches in Caucasian women (31 inches in Asian women)
  • Fasting blood sugar (glucose)--greater than or equal to 100 milligrams per deciliter (mg/dl)
  • Serum triglycerides--greater than or equal to 150 mg/dl
  • Serum HDL (“good”) cholesterol--less than 40 mg/dl in men and less than 50 mg/dl in women
  • Blood pressure--greater than or equal to 130/85 millimeters of mercury (mm Hg)
Treatment:
The treatment of metabolic syndrome involves two parts: treatment of underlying causes and treatment of specific metabolic abnormality.

Treatment of Underlying Causes

  • Reducing excess weight by at least 10% in the next 6-12 months
  • Increasing physical activity to 30-60 minutes of moderate aerobic exercise four or more days per week
  • Lowering blood pressure to below 130/85 mmHg with diet, exercise, and possibly medication
  • Improving triglyceride and HDL cholesterol levels through diet, exercise, and possibly medication

Treatment of Specific Metabolic Abnormality

  • High blood pressure with medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor antoagonists)
  • Insulin resistance with medications such as metformin or thiazolidinediones
  • High blood lipids with ezetimibe, fibrates, nicotinic acid
Prevention:
To help prevent metabolic syndrome:
  • Achieve and maintain a healthful weight.
  • Do 30 minutes of moderate aerobic exercise at least four days per week.
  • See your healthcare provider regularly.

In addition, other unhealthy lifestyle factors also contribute to heart disease, stroke, and peripheral vascular disease. To lower your risk of these diseases:

  • Eat a healthful diet, low in saturated fat and trans fatty acids and cholesterol, and high in whole grains, fruits, and vegetables.
  • Quit smoking.
  • Drink alcohol in moderation only.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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