The Metabolic Syndrome

The metabolic syndrome, which affects about one-quarter of all adults in the U.S., has emerged as just as strong a contributor to early heart disease as cigarette smoking. Those with the metabolic syndrome are also at increased risk of developing diabetes.

The metabolic syndrome, also known as syndrome X or insulin resistance syndrome, is a constellation of metabolic risk factors that significantly increases the risk for coronary events. The metabolic syndrome is identified by the presence of three or more of the following:

• abdominal obesity (waist circumference >40 inches in men or >35 inches in women);
• triglycerides >150 mg/dL;
• HDL cholesterol <40 mg/dL in men or <50 mg/dL in women;
• blood pressure >130 systolic or >85 diastolic
• fasting glucose >110 mg/dL.

First-line therapy for the metabolic syndrome is Theraputic Lifestyle Change (TLC), especially weight loss and physical activity, to address the underlying causes of overweight/obesity and physical inactivity.

TLC is a set of things you can do to help improve the metabolic syndrome. The main parts of TLC are:

• The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain.
• Weight Management. Losing weight is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
• Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

In addition to Theraputic Lifestyle Change the following treatments are used

• Aspirin 81mg. The Metabolic Syndrome results in a "Prothrombotic State" or enhanced tendency to form blood clots inside arteries. Low dose aspirin has been shown to counteract this tendency.
• Drugs to control blood pressure.
• Drugs to lower Cholesterol which is often also elevated.
• Further research is underway to determine if drugs such as Metformin are appropriate for patients with impaired fasting glucose.

More Information

• "Live Healthier, Live Longer"--information on cholesterol lowering
• "Aim for a Healthy Weight"
• "Your Guide to Lowering High Blood Pressure"
• www.fitness.gov