From the Guidelines
Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke, and type 2 diabetes, and it is diagnosed when a person has at least three of the following five risk factors: abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol. The diagnosis of metabolic syndrome is made when three or more of the following features are present:
- 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 or <1.3 mmol/l (<50 mg/dl) in females
- blood pressure ≥130/85 mmHg
- plasma glucose ≥6.1 mmol/l (≥110 mg/dl) 1. However, the most recent and highest quality study, which is a joint interim statement of the international diabetes federation task force on epidemiology and prevention, recommends that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool, and three abnormal findings out of 5 would qualify a person for the metabolic syndrome 1. The underlying causes of metabolic syndrome are complex but include insulin resistance, where cells don't respond properly to insulin, leading to higher blood sugar levels, and lifestyle factors such as physical inactivity, poor diet, and excess weight significantly contribute to its development 1. Management focuses on lifestyle modifications including regular exercise, a balanced diet rich in fruits, vegetables, and whole grains while limiting processed foods and sugars, weight loss of 5-10% if overweight, and smoking cessation, which can dramatically improve all components of metabolic syndrome and reduce the risk of developing serious health complications 1. It is also important to note that lifestyle has a strong influence on all the components of the metabolic syndrome and therefore the main emphasis in the management of the metabolic syndrome should be in professionally supervised lifestyle changes, particularly efforts to reduce body weight and increase physical activity 1. In addition, elevated BP, dyslipidaemia, and hyperglycaemia (in the diabetic range) may, however, need additional drug treatment as recommended in the present guidelines 1. Overall, the management of metabolic syndrome requires a comprehensive approach that includes lifestyle modifications and, when necessary, pharmacological treatment to reduce the risk of cardiovascular disease and type 2 diabetes.
From the Research
Definition of Metabolic Syndrome
Metabolic syndrome is a clustering of different risk factors that collectively increases the risk of developing cardiovascular disease and type 2 diabetes mellitus 2. The syndrome itself is associated with various metabolic abnormalities, including insulin resistance, non-alcoholic fatty liver disease, obstructive sleep apnoea, male hypogonadism and polycystic ovary syndrome.
Key Components of Metabolic Syndrome
The components of metabolic syndrome include:
- Abdominal obesity
- Impaired glucose metabolism
- Dyslipidemia
- Hypertension 3
- Atherogenic dyslipidaemia
- Elevated blood pressure
- Raised plasma glucose
- A prothrombotic and a proinflammatory states 4
Underlying Risk Factors
The two major underlying risk factors for the metabolic syndrome are:
- Obesity
- Insulin resistance 4 These risk factors are exacerbated by physical inactivity, advancing age, endocrinal and genetic factors.
Therapeutic Approach
The therapeutic approach involves intervention at a macro-level and control of multiple risk factors using therapeutic lifestyle approaches (diet control and increased physical activity, pharmacotherapy - anti-obesity agents) for control of obesity and visceral obesity, and targeted approach for control of individual risk factors 5. Pharmacological therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals.
Management of Individual Components
Management of individual components of metabolic syndrome includes:
- Control of atherogenic dyslipidemia with statins
- Control of insulin resistance with drugs such as thiazolidinediones and renin-angiotensin system blockers
- Control of hypertension with angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBS)
- Use of aspirin for primary prevention in patients with metabolic syndrome 5