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Identifying Metabolic Syndrome

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Metabolic dysfunctions are fast becoming major risk factors for cardiovascular incidents ie. myocardial infarction, stroke, and non-ischemic cardiovascular disease. The constellation symptoms indicative of metabolic dysfunction include: central obesity (apple body types), glucose intolerance and insulin resistance (eg. non-insulin-dependent diabetes mellitus), hypertension, dyslipidemia, high markers of inflammation, and poor clotting (hyperfibrinolysis). Given the wide array of symptoms metabolic syndrome was often overlooked, though the current criteria have been established, with three of the five required for diagnosis:

Criteria Defining Value
Abdominal obesity Waist circumference: Women >88 cm men >102 cmWaist to hip ratio: women >0.85 and men > 1.0
High Triglycerides ≥150 mg/dL
Lowered HDL cholesterol <40 mg/dL in men and <50 women mg/dL
Increased Blood pressure ≥130/85 mm Hg
Elevated Fasting glucose ≥110 mg/dL

 

Abdominal Obesity:
In recent years attention has shifted from total fat to the distribution of fat on a person’s body. The classic apple body type, with the majority of weight carried centrally on the torso ( as opposed to lower on the hips) has been implicated as a risk factor for cardiovascular disease. While this correlation was discovered some time ago, theories into the exact mechanism of this increased risk are still being investigated. A leading theory is that central obesity is indicative of increased visceral fat ( or fat surrounding the organs), which is often highly metabolically active. This  increased adipose tissue releases more free fatty acids and proinflammatory cytokines.

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 Dyslipidemia:
As mentioned above dyslipidemia is part of the diagnostic criteria for metabolic syndrome, but what does that mean exactly? Well simply put it means high tryglycerides, low HDL cholesterol, and high amounts of LDL cholesterol. In order to understand the implications you can review the role of cholesterol in the body and how it can become deregulated.

Insulin Resistance:
People with chronically elevated blood sugar levels are twice as likely to suffer from cardiovascular disease and are five times more likely to experience a heart attack. Other frequent complications of having unstable blood sugar levels include retinal damage, blindness (this constitutes 8% of blindness cases in the US), unhealthy blood pressure levels (73% of persons with blood sugar disorders have elevated blood pressure), neuropathy (affecting 60-70% of patients with blood sugar disorders), unhealthy blood vessels, dental disease, increased susceptibility to infections, stroke, kidney failure (main cause of dialysis in developed countries) and ulcer formation, which can lead to tissue damage and amputation (one amputation every 30 seconds worldwide). In some patients, especially earlier in the disease process, exercise, dietary changes and weight loss may restore insulin sensitivity and normalize blood sugar levels. Patients that control their blood sugar levels minimize the damage to their organs (mainly kidneys, blood vessels and eyes) and their incidence of complications is significantly reduced and nearly normal.

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High Blood Pressure:
19% of Canadian adults have an unhealthy blood pressure level. Having an unhealthy blood pressure level can lead to serious health problems such as heart disease, heart attack and stroke. It has been estimated that a reduction of 5 mmHg in systolic BP could reduce stroke mortality by 14% and decrease cardiovascular disease mortality by 9%.

 

Stay tuned for Part 2 where we discuss some management tools.

1 Comment

  1. Dr. Andrew Caine Reply

    This kind of information is very relevant to treatment procedures in my state. While at Tulane, studies relevant to early childhood obesity were often discussed in cardiovascular discussions. On the bayou especially you’ll see a lot of the problems you’ve outlined.

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