A Synopsis of AFP's "Metabolic Syndrome: Time for Action"

Metabolic Syndrome: Time for Action
DARWIN DEEN, M.D., M.S., Albert Einstein College of Medicine of Yeshiva University, Bronx, New York
Am Fam Physician. 2004 Jun 15;69(12):2875-2882.
http://www.aafp.org/afp/2004/0615/p2875.pdf

     Metabolic syndrome is an independent risk factor for cardiovascular disease and new onset diabetes. The diagnostic criteria for metabolic consists of;
(1) a waist circumference of 40in in men or 35in in women,
(2) a triglyceride level above 150 mg/dL,
(3) a HDL less than 35 mg/dL in men or 39 mg/dL in women,
(4) a blood pressure above 140/90,
(5) an elevated fasting glucose (>110) (impaired glucose tolerance, insulin resistance, or diabetes), and
(6) microalbuminuria.
Lab work that may be related to metabolic syndrome include CRP, platelet aggregation, uric acid, LDL, plasmin activator inhibitor 1, and hyperfibrinogenemia. Other associated conditions include PCOS and NASH. Prevalence of metabolic syndrome is related to increased age and increased body weight.
     Metabolic syndrome is caused by either increased insulin resistance (causing endothelial dysfunction and vascular damage) or by elevated cortisol and alterations in the HPA axis.
     Clinical evaluation includes information about leisure activity and how much time during the day is spent sedentary. Treatment is individualized but focuses on reducing the risk factors. Weight loss will slow the onset of diabetes and cardiovascular disease. Exercise is another important aspect of reducing risk factors in these patients. According to this article, skeletal muscle has the most insulin-sensitive tissue. It also says that the impact of exercise on insulin sensitivity will last up to 5 days (which is why regular exercise is so important). Resistance training and aerobic activity is the best, but any program must be started gradually. Patients need constant encouragement and counseling.
    Diet can make a big impact on reducing risk factors of metabolic syndrome, new onset diabetes, and cardiovascular disease. There are many diets out there, so a referral to a nutritionist or dietitian may provide benefit to the patient. Alcohol used should be used only in moderation.
     Aspirin and statins play a role in benefit. as well, but lifestyle modification play a larger role.