Metabolic syndrome

Metabolic syndrome is a name for a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes.

Insulin resistance syndrome; Syndrome X

Metabolic syndrome is becoming more and more common in the United States.

Metabolic syndrome is associated with many conditions and risk factors. The two most important risk factors are:

• Extra weight around the middle of the body (central obesity). The body may be described as "apple-shaped."
• Insulin resistance, in which the body cannot use insulin effectively. Insulin is needed to help control the amount of sugar in the body.

Researchers are not sure whether the syndrome is due to one single cause. But many experts believe that insulin resistance is the main cause. Insulin helps blood sugar (glucose) enter cells.

If you have insulin resistance, your body doesn't respond to insulin and blood sugar can't get into cells. As a result, the body produces more and more insulin. Insulin and blood sugar levels rise, affecting kidney function and raising the level of blood fats, such as triglycerides.

Other risk factors include:

• Aging
• Genes that make you more likely to develop this condition (genetic predisposition)
• Hormonal changes
• Lack of exercise

Alone, the symptoms can cause medical issues. Combined, they can present severe health problems.

Symptoms include:

• Extra weight around your waist (central or abdominal obesity)
• High blood pressure
• High triglycerides (a type of blood fat)
• Insulin resistance
• Low HDL ("good") cholesterol

Tests that may be done to diagnose metabolic syndrome include:

• Blood pressure measurement
• Glucose test
• HDL cholesterol level
• LDL cholesterol level
• Total cholesterol level
• Triglyceride level

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following:

• Blood pressure equal to or higher than 130/85 mmHg
• Blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

The goal of treatment is to reduce your risk of heart disease and diabetes. Your doctor will recommend lifestyle changes or medicines to help reduce your blood pressure, LDL cholesterol, and blood sugar.

Smoking should be avoided.

People with metabolic syndrome have an increased long-term risk for developing cardiovascular disease and type 2 diabetes.

• Aortic stenosis
• Atherosclerosis
• Diabetes
• Heart attack
• Kidney disease
• Non-alcoholic fatty liver disease
• Peripheral artery disease
• Stroke

Call your health care provider if you have signs or symptoms of this condition.

Preventing (and managing) the condition involves:

• Eating a diet low in fat, with a variety of fruits, vegetables and whole-grain products
• Getting regular exercise, at least 30 minutes of moderate activity almost every day
• Losing weight so that your body mass index (BMI) is less than 25
• Managing blood pressure and blood sugar
• Not smoking
• Trying to include fish, preferably oily fish, in your diet at least twice a week

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Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA,et al. American Heart Association; National Heart, Lung, and Blood Institue. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Cardiol Rev. 2005;13:322-327.