Metabolic syndrome

Definition

Metabolic syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes.

Alternative Names

Insulin resistance syndrome; Syndrome X

Causes, incidence, and risk factors

Metabolic syndrome is becoming more and more common in the United States. Researchers are not sure whether the syndrome is due to one single cause, but all of the risks for the syndrome are related to obesity.

The two most important risk factors for metabolic syndrome are:

• Extra weight around the middle and upper parts of the body (central obesity). The body may be described as "apple-shaped."
• Insulin resistance. The the body uses insulin less effectively than normal. Insulin is needed to help control the amount of sugar in the body. As a result, blood sugar and fat levels rise.

Other risk factors include:

• Aging
• Genes that make you more likely to develop this condition
• Hormone changes
• Lack of exercise

People who have metabolic syndrome often have two other problems that can either cause the condition or make it worse:

• Excess blood clotting
• Increased levels of blood substances that are a sign of inflammation throughout the body

Symptoms

Signs and tests

Metabolic syndrome is present if you have three or more of the following signs:

• Blood pressure equal to or higher than 130/85 mmHg
• Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
  • Men - 40 inches or more
  • Women - 35 inches or more
• Low HDL cholesterol:
  • Men - under 40 mg/dL
  • Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

Treatment

The goal of treatment is to reduce your risk of heart disease and diabetes.

Your doctor will recommend lifestyle changes or medicines to help reduce your blood pressure, LDL cholesterol, and blood sugar.

• Lose weight. The goal is to lose between 7% and 10% of your current weight. You will probably need to eat 500 - 1,000 fewer calories per day.
• Get 30 minutes of moderate intensity exercise, such as walking, 5 - 7 days per week.
• Lower your cholesterol using weight loss, exercise, and cholesterol lowering medicines, if needed.
• Lower your blood pressure using weight loss, exercise, and medicine, if needed.

Some people may benefit from daily low-dose aspirin.

People who smoke should quit.

Support Groups

Expectations (prognosis)

People with metabolic syndrome have an increased long-term risk for developing heart disease, type 2 diabetes, stroke, kidney disease, and poor blood supply to the legs.

Complications

Calling your health care provider

Call your health care provider if you have signs or symptoms of this condition.

Prevention

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References

Inzucchi SE, Sherwin RS. Type 2 diabetes mellitus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 237.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention: National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640-1645.

Rosenzweig JL, Ferrannini E, Grundy SM, Haffner Sm, Heine RJ, Horton ES, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008; 93:3671-3689.