Posts Tagged ‘Metabolic Syndrome’
Metabolic syndrome is a grouping of cardiac risk factors that result from insulin resistance (when the body’s tissues do not respond normally to insulin). A person with metabolic syndrome has a greatly increased risk of cardiovascular disease and premature death.
The risk factors seen in metabolic syndrome include: insulin resistance, obesity (especially abdominal obesity), high blood pressure, abnormalities in blood clotting, and lipid abnormalities. Specifically, metabolic syndrome is diagnosed if any three of the following are present:
• Elevated waist circumference: 40 inches or more for men; 35 inches or more for women
• Elevated triglycerides: 150 mg/dL or higher
• Reduced HDL (“good”) cholesterol: less than 40 mg/dL in men; less than 50 mg/dL in women
• Elevated blood pressure: 130/85 mm Hg or higher
• Elevated fasting glucose: 100 mg/dL or higher
Why Are These Risk Factors Grouped Together in Metabolic Syndrome?
Metabolic syndrome is linked to your body’s metabolism, possibly to a condition called insulin resistance. Insulin is a hormone made by your pancreas that helps control the amount of sugar in your bloodstream. In the body’s attempt to compensate for insulin resistance, extra insulin is produced, leading to elevated insulin levels. Frequently, the insulin resistance will progress to overt type 2 diabetes, which further increases the risk of cardiovascular complications. In fact, another name for metabolic syndrome is pre-diabetes.
Who Gets Metabolic Syndrome?
Metabolic syndrome tends to run in families, along with the propensity for type 2 diabetes. Metabolic syndrome will occur in susceptible people who become overweight and sedentary. So, metabolic syndrome (like type 2 diabetes) can most often be prevented with exercise and maintaining a healthy body weight.
Treatment of Metabolic Syndrome
Treating the Insulin Resistance
Without going into too much detail, sometimes diabetes medications may be necessary. Medications such as metformin (Glucophage®), thiazolidinedione drugs like troglitazone (Rezulin®) and acarbose (Precose®), alone or in combination, have been used to improve insulin sensitivity mainly by reducing plasma glucose by different mechanisms. Alpha-glucosidase inhibitors include acarbose and miglitol, which can help lower the absorption of sugar and carbohydrates in the intestines, reducing the absorption of sugar after meals. As you may suspect, diet and exercise (again) is crucial in the management of insulin resistance.
Treating Lipid Abnormalities
While the lipid abnormalities seen with metabolic syndrome (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise, drug therapy is often required. Treatment should be aimed primarily at reducing LDL levels according to specific recommendations. Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made. Successful drug treatment usually requires treatment with a statin, a fibrate drug, or a combination of a statin with either niacin or a fibrate.
Treating the Clotting Disorder
Patients with metabolic syndrome can have several disorders of coagulation that make it easier for blood clots to form within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic syndrome should generally be placed on daily aspirin therapy to help prevent such clotting events.
Treating the Hypertension
High blood pressure is present in more than half the people with metabolic syndrome and, in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Adequate blood pressure treatment in these individuals can substantially improve their outcome.
The key to preventing and metabolic syndrome, however, remains diet and exercise; let me say it again: diet and exercise.
To read future blog posts from Dr. Vicente Font, visit the Jim Moran Heart & Vascular Center Blog.
In my last blog I wrote about the Metabolic Syndrome. This syndrome figures very prominently in the day to day practice of medicine. The syndrome increases the risk of death and can be treated. However, the treatment is very difficult. Guess what the best treatment is…losing some weight. Although I am not kidding we all know just how difficult that can be.Therapeutic lifestyle modification which includes reducing weight, the total intake of fat and saturated fat, increasing the intake of fiber and increasing physical activity can make a major difference.
In one study of 522 patients 172 men and 350 women who were followed for 3.2 years the risk of diabetes was reduced by 58%. In another study the average weight loss in the treatment group was 9lbs and in the control group was 1.75 lbs.
After therapeutic lifestyle modification, medicine helps to control many of the factors. Stopping smoking is of course a major concern and in another blog I will write about the issues with the various methods.
The drugs are the standard ones we use to treat the specific issues. For high blood pressure, ACE (angiotensin converting enzyme) inhibitors are very helpful. They also are useful in the protection of kidney function in those patients who have diabetes. If you are allergic to ACE inhibitors than ARB’s (angiotensin receptor blockers) are useful but more expensive as they are not yet generically produced.
The treatment of high triglycerides and low HDL is difficult as this is often genetically based. Exercise will help raise HDL’s by 10% and weight lose will often be enough to bring the triglycerides into range. The use of statins will help some, and they are often used because the entire lipid profile is off. Fibrates and niacin are also helpful, but as mentioned in other blogs (July 30, June 19) we are now working on a drug to use instead of niacin because of its poor tolerability.
Diabetes is treated in the usual manner by diet and at times medication, metformin is very useful in this syndrome. Exercise also helps.
Often patients are sick through no fault of their own. This is one area that hard work and lifestyle can make you better. If you think you have this the next step is simple, see your doctor and get to work. The life you save is your own.
One of the challenges in the practice of medicine today is the general obesity of the population. In cardiology we share a syndrome with the endocrinologists called the Metabolic Syndrome.
This syndrome is defined by several factors of which at least three are required for diagnosis.
1. Central Obesity which is defined as waist
circumference > 40 inches for male or 36 inches
2. Dyslipidemia Triglycerides >150 mg/dl
3. Dyslipidemia HDL C <40 for male or <50 for female
4. Blood pressure > 130/85
5. Elevated fasting glucose >100 mg/dl or the use
of diabetic medication
One can easily see just how many people fall into this syndrome. The hope is that by identifying those people with it treatment programs can be put into place that will limit the long-term risk. One study published in 2008 looked at over 30,000 men enrolled in an aerobics program from 1979 to 2004. All the individual risks were associated with increased death; both all causes and cardiovascular. The most worrisome aspect was the finding that this was additive. The more risk factors the higher the risk of death.
This syndrome at least doubles the risk of developing cardiovascular disease. Many of these patients go on to develop type 2 diabetes. Additionally, this syndrome is associated with increased levels of C-reactive protein and other proinflammatory cytokines. Although this is not a therapeutic target it does help with treatment choices.
Next: what can be done to help.