Metabolic syndrome is a cluster of metabolic disorders which when present increases the risk of cardiovascular disease. It arises from insulin resistance accompanying abnormal adipose deposition and function and is also a risk factor for diabetes, fatty liver, and several cancers.
Metabolic syndrome occurs when a person has three or more of the following
- Abdominal obesity (Waist circumference of greater than 40 inches in men, and greater than 35 inches in women)
- Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater
- HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
- Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater
- Fasting glucose of 100 mg/dL or greater
Risk factors for metabolic syndrome include family history, poor diet, and inadequate exercise.
Exact pathway of development if this condition is not known. Increased thyroid stimulating hormone (TSH) has been linked to a higher prevalence of metabolic syndrome.
Hyperuricemia appears to be much more common in patients with metabolic syndrome.
Risk factors for Metabolic syndrome
- Insulin resistance
- Sedentary lifestyle
- Diet (sugar-sweetened beverage consumption)
- Family history
- Low physical activity
- Disrupted sleep
- Mood disorders/psychotropic medication
- Excessive alcohol use.
Insulin resistance appears to be the primary mediator. Insulin promotes glucose uptake in muscle, fat, and liver cells.
Abnormalities in insulin secretion and insulin receptor signaling, impaired glucose disposal, and proinflammatory cytokines are additional factors. These abnormalities, may result from obesity with related increases in free fatty acid levels and changes in insulin
Clinical Presentation of Metabolic syndrome
The condition is diagnosed based on clinical presentation and laboratory tests. [see the criteria given above]
Clinically the suspicion may arise if there is increased hunger, thirst, or urination [suggestive of hyperglycemia]
If there is history of hypertension, dyslipidemia, or hyperglycemia, such as chest pain or shortness of breath, must be investigated to rule out metabolic syndrome.
Tobacco use and family history of the consdition should be enquired about.
Measurement and documentation of waist circumference to assess abdominal obesity.
The examination reveal findings like acanthosis nigricans, hirsutism, peripheral neuropathy, and retinopathy attributable to insulin resistance and hyperglycemia diabetes mellitus.
Similarly with severe lipid disorders xanthomas or xanthelasmas may be seen.
- Blood glucose levels
- renal function tests
- lipid studies to assess for hypertriglyceridemia or low HDL levels.
If a family history of early coronary or other atherosclerotic disease is present
- High-sensitivity C-reactive protein (CRP
- Fractionated LDL-C.
Further studies should be pursued as clinical findings dictate.
Imaging studies are not routinely indicated
If there is a chest pain, dyspnea, or claudication following may be done if required
- Rest/stress ECG
- Rest/stress echocardiography
- Stress single-photon emission computed tomography
- Cardiac positron emission tomography
Sleep-related studies in obstructive sleep apnea should be done.
Treatment of Metabolic syndrome
The approach to management of metabolic syndrome involves
Lifestyle modifications like diet, activity. Drugs are used when required.
Diets rich in dairy, fish, and cereal grains is associated with a lower risk of developing metabolic syndrome.
Moderate wine intake may protect against the development and complications of this condition.
Higher fructose diets should be curtailed.
Drugs as needed for
- Control of blood pressure
- Correction of Lipid Levels
- Fibrate therapy
- Omega-3 polyunsaturated fatty acid
- Hypglycemic drugs such as metformin [also increases insulin sensitivity]
- Preventive cardiovascular treatment
- Treatment of associated obstructive sleep apnea
Excessive sitting and other sedentary behavior are contributory to the development of metabolic syndrome.
Exercise therefore is an important intervention.
The current recommendation regular moderate-intensity physical activity for at least 30 minutes continuously at least 5 days per week for patients with this syndrome.
Achieving moderate intensity activity for 120 to 150 minutes a week may reduce the risk of developing metabolic syndrome.
Those who have this syndrome, physical activity reduces the risk of developing of developing coronary heart disease.
Complications of Metabolic Syndrome
- Coronary heart disease
- Atrial fibrillation
- Heart failure
- Aortic stenosis
- Ischemic stroke
- Venothromboembolic disease.
- Risk of stroke.
- Neuropathy [through inflammatory mediators]
- Nonalcoholic fatty liver disease
- obstructive sleep apnea.
- Breast cancer has also been linked to metabolic syndrome,
- cancers of the colon, gallbladder, kidney, and, possibly, prostate gland.
- Neurocognitive dysfunction