Metabolic Syndrome

By Seth Bilazarian, MD, FACC, FSCAI, RPVI
Clinical and Intervential Cardiologist

What is the Metabolic Syndrome?
The Metabolic Syndrome is a collection of five problems that greatly increase a person’s risk for
stroke, heart attack and diabetes. These five characteristics are:

1. Hypertension (On treatment for high blood pressure
   or blood pressure greater than 130 without medication)
2. Abnormal Blood Sugar (over 100 when fasting)
3. Abnormal Triglycerides (over 150 when fasting)
4. Low levels of HDL “good cholesterol”(less than 40 for
   men and 50 for women)
5. Obesity with fat especially in the abdominal area (waistline
   of 40 inches or more for men and 35 inches or more for
   women measured across the belly)

A physician generally makes this diagnosis if three of these five problems are present. 

How big a problem is it?
The Metabolic Syndrome has become increasingly common in the United States, and it’s estimated that over 50 million Americans have it. According to a national health survey, more than one in five Americans has metabolic syndrome and the number is increasing. The Metabolic Syndrome increases with age, affecting more than 40% of people in their 60s and 70s.

Who typically has Metabolic Syndrome?
According to the American Heart Association, three groups of people often have metabolic syndrome:

• People with diabetes who cannot maintain a proper level of glucose (glucose intolerance)
• People without diabetes who have high blood pressure and who also secrete large amounts of insulin (hyperinsulinemia) to maintain blood glucose levels
• Heart attack survivors who have hyperinsulinemia without glucose intolerance

What causes the Metabolic Syndrome?
Conditions associated with the Metabolic Syndrome include the body’s inability to metabolize insulin efficiently. This problem of insulin resistance is at the heart of the problem. Contributing factors also may include physical inactivity, aging, hormonal imbalance and family history, but being overweight is the most important aspect of the problem.  

Why is it important?
The Metabolic Syndrome is a strong predictor of diabetes and vascular problems like stroke and heart attack. Consistently high levels of insulin and sugar increase health risks by: 

• Damage to the lining of arteries, a key step in the development of heart disease or stroke
• Changes in the kidneys' ability to remove salt, leading to high blood pressure, heart disease and stroke
• Increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease
• Increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes
• Slowing of insulin production, which can signal the start of type 2 diabetes

How can the risk be reduced?
Physical inactivity and excess weight are the main contributors to metabolic syndrome development, getting more exercise and losing weight reduces the complications.  Your doctor may prescribe medications to manage some of the underlying problems to reduce your risk:
Lose weight--Moderate weight loss, in the range of 5 - 10 % of body weight, can reduce your body's resistance to insulin and reduce complications.
Exercise--Increased activity alone can improve insulin levels. A 30-minute walk daily can reduce weight, improved blood pressure and cholesterol and reduce the risk of developing diabetes.
Dietary changes--Keep carbohydrates to less than 50 percent of total calories. Eat complex carbohydrates, such as whole grain bread (instead of white), brown rice (instead of white), and  avoid refined sugars ( for example candy and pastry). Increase fruits and vegetables and reduce intake of red meats and poultry. Consume healthy fats such as those in canola oil, olive oil, flaxseed oil and nuts.
Limit alcohol --Consume no more than one drink a day for women or two drinks for men.
See your doctor – “Knowing your numbers” – blood pressure; cholesterol, blood sugar and ideal weight can be the first step

The primary goals of treatment plans include steps to reduce cardiovascular risk. Patients are encouraged to stop smoking, reduce LDL cholesterol and blood pressure and to monitor blood sugar. Diet and exercise are the best initial strategy, but medications may also be prescribed.