Cardiac & VascularCardiac and VascularDiseases and Conditions

Metabolic Syndrome

(Syndrome X; Insulin Resistance Syndrome; Dysmetabolic Syndrome)
  • Definition

    Metabolic syndrome is a group of risk factors for cardiovascular disease. The factors are related to the breakdown and use of food and the action of the hormone insulin. These conditions are risk factors for health issues, such as:
    • Type 2 diabetes
    • Coronary artery disease
    • Heart attack
    • Stroke
    • Peripheral vascular disease
    In general, metabolic syndrome is characterized by:
    • Abdominal obesity — high amount of fat around the waist
    • Low levels of "good cholesterol", also called high density lipoprotein (HDL) cholesterol
    • High triglyceride level — type of fat measured in the blood
    • High blood pressure
    • Insulin resistance (glucose intolerance or prediabetes) — insulin helps move glucose out of the blood into cells, resistance increases blood glucose levels
    Coronary Heart Disease
    Stereostatic Biopsy
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  • Causes

    The exact cause of metabolic syndrome is not known. It believed to be due to a combination of factors, such as:
    • Genetic factors
    • Insulin resistance
    • Obesity (especially central obesity)
    • Lack of physical activity
    • Poor diet
    • Fatty tissue abnormalities linked to insulin resistance and obesity
    • Psychological stress
    • Chronic low-grade inflammation
    • Aging
  • Risk Factors

    Risk factors for metabolic syndrome may include the following:
    • Overweight (especially excessive fat in the abdominal region)
    • Poor diet leading to weight gain
      • Eating a diet high in calories, sugar, saturated fats, and starchy foods (eg, bread, cereal, rice, pasta, potatoes), and low in dietary fiber
      • Drinking a lot of soda, including diet soda
    • Sedentary lifestyle
    • Gender
      • No difference in Caucasians
      • African Americans: females more than males by 57 percent
      • Mexican Americans: females more than males by 26 percent
    • Genetics: family history of diabetes, lipid disorders, high blood pressure, or heart disease
    • Socioeconomic factors: low income
    • Age: over 60 years old
    • Ethnicity: Latino/Hispanic American, African American, Native American, Asian American, Pacific Islander
    • 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
  • Symptoms

    Except for obesity, there are no obvious symptoms. The following symptoms are associated with obesity:
    • Sleep apnea
    • Back or knee pain
    • Shortness of breath
    • Reduced exercise tolerance
    • Fatigue
    • Central obesity
    • Elevated blood pressure
  • Diagnosis

    The doctor will ask about your medical history. A physical exam will be done. Your doctor may order lab tests, such as:
    • Blood tests to measure:
      • Glucose levels
      • Hemoglobin A1c
      • Insulin levels
      • Triglyceride level
      • Cholesterol levels
      • C reactive protein
    • Blood pressure
    • Urine test for protein
    • Calculation of body mass index (BMI)
    • Measurement of waist circumference
    • Calculation of 10-year risk of cardiovascular disease
    According to the National Heart Lung and Blood Institute, you may be diagnosed with metabolic syndrome if you have at least three of the following:
    • Waist measurement — greater than 40 inches in Caucasian men (35 inches in Asian men) or 35 inches in Caucasian women (30 inches in Asian women)
    • Fasting glucose level — greater than or equal to 100 mg/dL* (5.55 mmol/L)
    • Triglyceride level — greater than or equal to 150 mg/dL (1.7 mmol/L)
    • HDL cholesterol — less than 40 mg/dL (1.0 mmol/L) in men and less than 50 mg/dL (1.3 mmol/L) in women
    • Blood pressure — greater than or equal to 130/85 millimeters of mercury (mm Hg)
    *mg/dL = milligrams per deciliter blood, mmol/L = millimoles per liter blood
  • Treatment

    The treatment of metabolic syndrome involves:
    • Treatment of underlying causes
    • Treatment of specific metabolic abnormality
    Gastric bypass or other weight loss surgery may be helpful to treat metabolic syndrome. Talk to your doctor to learn if this is an option for you.

    Treatment of Underlying Causes
    • Reducing excess weight by at least 10% in the next 6 to 12 months
    • Increasing physical activity to 30 to 60 minutes of moderate aerobic exercise four or more days per week (if approved by your doctor)
    • Lowering blood pressure to below 130/85 mmHg with diet, exercise, and possibly medicine
    • Improving triglyceride and HDL cholesterol levels through diet, exercise, and possibly medicine
  • Treatment of Specific Metabolic Abnormality
    • High blood pressure — treated with anti-hypertensive medicines
    • Insulin resistance — treated with diabetes medicines (eg, metformin) and lifestyle changes (eg, exercise)
    • High cholesterol — treated with cholesterol-lowering medicines called statins
    • Clotting tendency — treated with low-dose aspirin (especially in those with moderate to high cardiovascular risk)
  • Prevention

    To help prevent metabolic syndrome:
    • Achieve and maintain a healthy weight.
    • Do 30 minutes of moderate aerobic exercise at least four days per week.
    • See your doctor 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 healthy diet. It should be low in saturated and trans fats. Also keep it low in cholesterol. Aim for a diet that is rich in whole grains, fruits, and vegetables. Avoid soda. Ask your doctor if the Mediterranean diet is right for you.
    • If you smoke, quit. Smoking greatly increases cardiovascular risk.
    • Drink alcohol in moderation. This means no more than two drinks daily for men, one drink daily for women.

    American Heart Association

    National Institute of Diabetes & Digestive & Kidney Diseases


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