What are the diagnosis and treatment options for Metabolic Syndrome?

From the Guidelines

Metabolic syndrome is diagnosed and treated most effectively by addressing its components through lifestyle modifications and, when necessary, medication, with the goal of reducing the risk of developing type 2 diabetes and cardiovascular disease, as emphasized in the most recent guidelines 1.

Diagnosis of Metabolic Syndrome

The diagnosis of metabolic syndrome is made by the presence of at least three of the following five risk factors:

• Elevated waist circumference
• Elevated serum triglycerides (≥150 mg/dL)
• Reduced HDL cholesterol (<40 mg/dL in men or <50 mg/dL in women)
• Elevated blood pressure (≥130/85 mmHg)
• Elevated fasting glucose (≥100 mg/dL)

Treatment Options

Treatment primarily focuses on lifestyle modifications, including:

• A Mediterranean or DASH diet emphasizing fruits, vegetables, whole grains, and lean proteins while reducing processed foods and added sugars
• Regular physical activity of at least 150 minutes of moderate exercise weekly
• Weight loss of 5-10% of body weight, which can significantly improve all components of metabolic syndrome, as supported by recent studies 1

Medication may be necessary for specific components:

• Statins like atorvastatin (10-80 mg daily) for dyslipidemia
• Metformin (starting at 500 mg daily, increasing to 1000-2000 mg daily) for elevated glucose
• Antihypertensives like ACE inhibitors (e.g., lisinopril 10-40 mg daily) for high blood pressure

Regular monitoring of blood pressure, lipids, and glucose levels is crucial to track progress, as highlighted in guidelines for the management of blood cholesterol 1 and the primary prevention of stroke 1.

Key Considerations

• Lifestyle modification is first-line therapy for metabolic syndrome, aiming for a 7% to 10% reduction in baseline weight over 6 to 12 months, as recommended in the management of comorbidities in chronic heart failure 1
• The diet should be low in saturated fats, trans fats, cholesterol, and simple sugars and incorporate an increased intake of fruits, vegetables, and whole grains
• The prevalence of metabolic syndrome is high and increasing, making early diagnosis and treatment critical to prevent complications, as noted in European guidelines on cardiovascular disease prevention 1

From the Research

Diagnosis of Metabolic Syndrome

• Metabolic syndrome is a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension 2
• The main diagnostic components are reduced HDL-cholesterol, raised triglycerides, blood pressure, and fasting plasma glucose, all of which are related to weight gain, specifically intra-abdominal/ectopic fat accumulation and a large waist circumference 3
• The diagnosis is based on the presence of three out of five of the following medical conditions: abdominal obesity, elevated blood pressures, elevated glucose, high triglycerides, and low high-density lipoprotein-cholesterol (HDL-C) levels 4

Treatment Options for Metabolic Syndrome

• The first step in management of patients with metabolic syndrome should be focused on lifestyle modifications, such as weight loss and physical activity 2
• A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months, and physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes 2
• Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals, and treatment should consist of treatment of individual component(s) 2, 5
• Available pharmacological agents for the treatment of metabolic syndrome include anti-obesity drugs, thiazolidinediones, metformin, statins, fibrates, renin-angiotensin system blockers, glucagon-like peptide-1 agonists, sodium glucose transporter-2 inhibitors, and some antiplatelet agents such as cilostazol 4
• Bariatric surgery offers an alternative treatment for those with BMI ≥ 40 or 35-40 kg/m(2) with other significant co-morbidity 3

Lifestyle Modifications

• Dietary recommendations include low intake of saturated fats, trans fats, and cholesterol, and diets with low glycemic index 2
• Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia 2
• A diet that includes more fruits, vegetables, whole grains, monounsaturated fats, and low-fat dairy products will benefit most patients with metabolic syndrome 6
• Weight loss and increasing physical activity significantly improve all aspects of metabolic syndrome 6

Pharmacological Therapy

• Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol, and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe 2, 5
• Drugs such as thiazolidinediones and renin-angiotensin system blockers are available for the treatment of insulin resistance 2, 5
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be more beneficial for treatment of hypertension in patients with metabolic syndrome compared to others 5