Robert Wood Johnson University Hospital
 

Metabolic Syndrome

Metabolic Syndrome

What is metabolic syndrome?

Metabolic syndrome is a condition that includes the presence of a cluster of risk factors specific for cardiovascular disease. Metabolic syndrome significantly raises the risk of developing diabetes, heart disease, and/or stroke.

Most people who have metabolic syndrome have insulin resistance. The body makes insulin to move glucose (sugar) into cells for use as energy. Obesity, commonly found in persons with metabolic syndrome, makes it more difficult for cells to respond to insulin. If the body cannot make enough insulin to override the resistance, the blood sugar level increases and diabetes can result. Metabolic syndrome may be a beginning of the development of type 2 diabetes.

The cluster of conditions and risk factors related to metabolic syndrome was first named in 1988. Dr. Gerald Reaven proposed that insulin resistance was central to the cause of type 2 diabetes, high blood pressure, and cardiovascular artery disease. Reaven called this cluster of abnormalities "Syndrome X." Since that time, Syndrome X has come to be known by various names, including metabolic syndrome, dysmetabolic syndrome, and insulin resistance syndrome. Syndrome X is now widely known as metabolic syndrome.

The American Heart Association (AHA) recognizes metabolic syndrome as a problem of growing concern, especially for those over age 60. Research suggests that more than 47 million Americans have it. Because the population of the United States is aging and because metabolic syndrome prevalence increases with age, the AHA has estimated that metabolic syndrome soon will become the primary risk factor for cardiovascular disease, ahead of cigarette smoking. Increasing rates of obesity are also thought to be related to the increasing rates of metabolic syndrome.

The cluster of metabolic factors involved as defined by the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) report, sponsored by the National Heart, Lung, and Blood Institute, includes:

The National Heart Lung and Blood Institutes (NHLBI) and the American Heart Association (AHA) recommend a diagnosis of metabolic syndrome when three or more of these factors are identified.

What causes metabolic syndrome?

Because of the involvement of several interconnected factors in metabolic syndrome, the direct cause is not clearly understood. The rise in obesity, coupled with a sedentary lifestyle, contribute to risk factors for metabolic syndrome, such as high cholesterol, insulin resistance, and high blood pressure. These risk factors may lead to cardiovascular disease and type 2 diabetes.

Because metabolic syndrome and insulin resistance are closely associated, many healthcare professionals believe that insulin resistance may be a cause of metabolic syndrome. However, a direct link between the two conditions has not been established. Others believe that hormone changes, caused by chronic stress, lead to the development of abdominal obesity, insulin resistance, and elevated blood lipids (triglycerides and cholesterol).

Other factors which are thought to contribute to the development of metabolic syndrome include genetic variations in a person's ability to break down lipids (fats) in the blood, older age, and abnormalities in the distribution of body fat.

What are the risk factors for metabolic syndrome?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Risk factors most closely associated with metabolic syndrome include:

What are the symptoms of metabolic syndrome?

While there are few symptoms experienced in metabolic syndrome, there may be several signs. A symptom is evidence of disease or physical disturbance that a person experiences and can describe. By contrast, a sign is objective evidence of disease as observed and interpreted by a physician or other clinician.

Factors such as high blood pressure, elevated triglycerides, and/or overweight or obesity may be signs of metabolic syndrome. Persons with insulin resistance may have acanthosis nigricans, which is darkened skin areas on the back of the neck, in the armpits, and under the breasts. In general, however, persons do not directly experience symptoms of metabolic syndrome.

The indications of metabolic syndrome may resemble other conditions. Consult your physician for a diagnosis.

How is metabolic syndrome diagnosed?

The National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III), the World Health Organization (WHO), and the American Association of Clinical Endocrinologists (AACE) have each developed a set of criteria to be used as an aid in diagnosing metabolic syndrome.

Included among the criteria of these organizations are:

Each organization has its own guidelines for using the above criteria to establish a diagnosis of metabolic syndrome.

Treatment for metabolic syndrome:

Specific treatment will be determined by your physician based on:

Because metabolic syndrome increases the risk for the development of more serious, chronic conditions such as cardiovascular disease and type 2 diabetes, treatment for metabolic syndrome is important. Other conditions that may develop as a result of metabolic syndrome include:

Types of treatment that may be recommended for metabolic syndrome include:

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