From the Guidelines
Metabolic syndrome is diagnosed when a patient has at least three of the following five criteria: waist circumference >102 cm in males or >88 cm in females, serum triglycerides ≥1.7 mmol/l, HDL-cholesterol <1 mmol/l in males or <1.3 mmol/l in females, blood pressure ≥130/85 mmHg, and plasma glucose ≥6.1 mmol/l. These criteria, as outlined in the European guidelines on cardiovascular disease prevention in clinical practice 1, identify individuals at high risk of cardiovascular disease. The management of metabolic syndrome should emphasize professionally supervised lifestyle changes, such as reducing body weight and increasing physical activity, as lifestyle has a strong influence on all components of the metabolic syndrome 1.
Key Criteria
- Waist circumference: >102 cm in males, >88 cm in females
- Serum triglycerides: ≥1.7 mmol/l (≥150 mg/dl)
- HDL-cholesterol: <1 mmol/l (<40 mg/dl) in males, <1.3 mmol/l (<50 mg/dl) in females
- Blood pressure: ≥130/85 mmHg
- Plasma glucose: ≥6.1 mmol/l (≥110 mg/dl)
Management
The main emphasis in managing metabolic syndrome should be on lifestyle changes, including efforts to reduce body weight and increase physical activity 1. However, elevated blood pressure, dyslipidaemia, and hyperglycaemia may require additional drug treatment as recommended in the guidelines 1. Regular monitoring of these parameters is essential for patients with one or more risk factors.
From the Research
Metabolic Syndrome Criteria
The metabolic syndrome diagnostic criteria include at least three of five of the following medical conditions:
- Abdominal obesity
- High blood pressure
- Abnormal high fasting plasma glucose
- Elevated serum triglycerides
- Low HDL (high-density cholesterol) level 2 These criteria are supported by various studies, including those published in 2005 by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) 3
Diagnostic Guidelines
Diagnosis guidelines establish the metabolic syndrome diagnostic when three of the following five conditions are met:
- Fasting glucose > or = 100 mg/dL or type 2 diabetes receiving drug therapy for hyperglycemia
- High blood pressure > or = 130/85 mm Hg or high blood pressure receiving drug therapy
- Triglycerides > or =150 mg/dL or treatment for plasma hyper-triglyceride value
- HDL-C < 40 mg/dL in men and < 50 mg/dL in women or if under therapy for reduced HDL-C levels
- Waist circumference of > or = 102 cm in men and > or = 88 cm in women 2
Components of Metabolic Syndrome
The components of metabolic syndrome include:
- Atherogenic dyslipidemia (elevated serum triglyceride and apolipoprotein B, increased small LDL particles, and reduced level of HDL cholesterol)
- Elevated blood pressure
- Elevated plasma glucose
- Central obesity 4 These components are interrelated and contribute to the increased risk of atherosclerotic cardiovascular disease (ASCVD) associated with metabolic syndrome 4, 5, 6
Risk Factors and Prevention
Risk factors for metabolic syndrome include sedentary lifestyle, overweight, and obesity 2 Prevention and treatment of metabolic syndrome involve lifestyle changes, such as diet and exercise, as well as pharmacologic interventions, including statins, antihypertensive drugs, insulin sensitizers, and thiazolidinediones 2, 3, 6