Metabolic Syndrome Diagnostic Criteria in Men: The Exception
HDL cholesterol of 50 mg/dL or higher is the criterion that does NOT fit with the others—in men, the diagnostic threshold for metabolic syndrome is HDL cholesterol BELOW 40 mg/dL, not 50 or higher. 1, 2
Correct Diagnostic Criteria for Metabolic Syndrome in Men
The harmonized definition requires any 3 of the following 5 criteria to diagnose metabolic syndrome: 1
The Five Actual Criteria:
Waist circumference ≥102 cm (≥40 inches) in men - This criterion listed in the question is CORRECT 1, 2
HDL cholesterol <40 mg/dL in men - The question states "50 or higher" which is INCORRECT. The actual criterion is HDL cholesterol BELOW 40 mg/dL, not above 50 mg/dL 1, 2
Serum triglycerides ≥150 mg/dL - This criterion listed in the question is CORRECT 1, 2
Blood pressure ≥130/85 mmHg - This criterion listed in the question is CORRECT 1, 2
Fasting glucose ≥100 mg/dL - Not mentioned in the question but is the fifth criterion 1
Why HDL of 50+ is Wrong
The confusion likely stems from the fact that women have a different HDL threshold—HDL <50 mg/dL in women is one of the diagnostic criteria. 1, 2 However, for men, the threshold is lower at <40 mg/dL because men physiologically have lower HDL cholesterol levels than women. 1, 2
Low HDL cholesterol is a risk factor, not high HDL. Having HDL cholesterol of 50 mg/dL or higher in men would actually be protective and desirable, not a criterion for metabolic syndrome. 1
Clinical Significance
This distinction matters because metabolic syndrome confers a 4-fold increased risk of fatal coronary heart disease in men and a 5-9 fold increased risk of developing type 2 diabetes. 1, 2 Correctly identifying all components ensures appropriate risk stratification and intervention. 1, 2