From the Guidelines
The initial workup for metabolic syndrome involves comprehensive laboratory testing and clinical assessment, focusing on lifestyle modifications and pharmacotherapy to reduce cardiovascular risk, as recommended by the most recent guidelines 1. The diagnosis of metabolic syndrome requires at least three of the following components: elevated waist circumference, triglycerides ≥150 mg/dL, reduced HDL, blood pressure ≥130/85 mmHg, or fasting glucose ≥100 mg/dL.
- Key components of the initial workup include:
- Measuring fasting blood glucose
- Lipid panel (including HDL, LDL, total cholesterol, and triglycerides)
- Blood pressure
- Waist circumference
- BMI
- Management primarily focuses on lifestyle modifications, including:
- A Mediterranean or DASH diet with caloric restriction aiming for 5-10% weight loss
- Regular physical activity (150 minutes of moderate-intensity exercise weekly)
- Smoking cessation
- Pharmacotherapy targets specific components, such as:
- Metformin for impaired glucose tolerance
- Statins like atorvastatin for dyslipidemia
- Antihypertensives such as ACE inhibitors or ARBs for hypertension The treatment of metabolic syndrome should include blood pressure control and treatment of additional risk factors based on level and overall cardiovascular risk, as stated in the 2020 International Society of Hypertension global hypertension practice guidelines 1. Regular follow-up every 3-6 months is essential to monitor progress and adjust treatment, addressing the underlying insulin resistance and reducing cardiovascular risk by targeting multiple metabolic abnormalities simultaneously, as supported by recent studies 1.
From the Research
Initial Workup for Metabolic Syndrome
The initial workup for metabolic syndrome involves assessing for the presence of three or more of the following five abnormalities:
- Waist circumference of >40 in (102 cm) for men or >35 in (88 cm) for women
- Triglyceride level of > or =150 mg/dL
- High-density lipoprotein cholesterol of <40 mg/dL in men or <50 mg/dL in women
- Blood pressure of > or =130 or > or =85 mm Hg
- Fasting glucose of > or =110 mg/dL 2
Diagnostic Criteria
The diagnostic criteria for metabolic syndrome include at least three of the five medical conditions:
- Abdominal obesity
- High blood pressure
- Abnormal high fasting plasma glucose
- Elevated serum triglycerides
- Low HDL (high-density cholesterol) level 3
Management Strategy
The management strategy for metabolic syndrome focuses on overall cardiovascular disease (CVD) risk rather than single risk factors, with priority given to:
- Weight reduction
- Increased physical activity
- Pharmacotherapy for control of high blood pressure, hypercoagulability, and increased levels of blood glucose and triglycerides 2
- Lifestyle changes, such as weight loss and increased physical activity, as first-line treatment 4
- Surgical options for weight loss in certain patients 4
- Pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, statins, and antihypertensives, for efficacy in treating individual components of the syndrome 4
Importance of Early Diagnosis
Early diagnosis of metabolic syndrome provides justification for measures that can improve components of the syndrome and reduce CVD risk, and is also predictive of new-onset type 2 diabetes 2, 5 The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions, and management should address all factors involved 5