Circulation. 2006;114:e528-e529
doi: 10.1161/CIRCULATIONAHA.106.633156
(Circulation. 2006;114:e528-e529.)
© 2006 American Heart Association, Inc.
The Metabolic Syndrome
Terry A. Lennie, PhD, RN
From the University of Kentucky, College of Nursing, Lexington, Ky.
Correspondence to Terry A. Lennie, PhD, RN, College of Nursing, 760 Rose St, Lexington, KY 40536–0232. E-mail tlennie{at}uky.edu
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What Is the Metabolic Syndrome?
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The metabolic syndrome is not a specific disease but a cluster
of factors, often occurring together in the same person, that
put one at risk for developing cardiovascular disease. There
is currently some debate regarding the specific definition of
the metabolic syndrome, but the most accepted group of factors
that are required to make the diagnosis are listed in
Table 1.
1 These factors are most frequently found in people with either
abdominal obesity, in whom most excess body fat is located in
the abdomen, or a decreased ability of the body to use insulin,
which is known as insulin resistance. A diagnosis does not require
all 5 risk factors. A person is considered to have the metabolic
syndrome if he or she has 3 or more of these factors. There
is a subgroup of white, black, and Hispanic adults who are genetically
predisposed to developing insulin resistance at lower waist
circumferences than those listed in
Table 1.
1
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How Common Is the Metabolic Syndrome?
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The percentage of people with the metabolic syndrome differs
by age group.
2 It is currently estimated that 13% of adolescents
in the United States have the metabolic syndrome. Approximately
24% of young to middle-aged adults and 40% of adults aged 70
years or older have the metabolic syndrome. The number of people
with the metabolic syndrome also differs by sex, race, and ethnicity.
2 Only 16% of black men have the metabolic syndrome, whereas 37%
of Hispanic women and 28% of Hispanic men have the syndrome.
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Why Should I Be Concerned About the Metabolic Syndrome?
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The cardiovascular risk factors associated with the metabolic
syndrome contribute to development of atherosclerosis, which
is also commonly referred to as hardening of the arteries. Atherosclerosis
is caused by a build-up of fatty deposits (plaque) along the
walls of the arteries in the heart and brain. Over time, this
plaque can rupture and cause a blood clot to develop, which
can lead to a heart attack or a stroke. People with the metabolic
syndrome who do not receive treatment have twice the risk of
developing atherosclerosis as do people without the syndrome.
This means that people with the metabolic syndrome also have
a much higher risk of having a heart attack or stroke. People
with the metabolic syndrome are also more likely to develop
type 2 diabetes mellitus. Those with type 2 diabetes mellitus
who also have the metabolic syndrome are at even higher risk
for atherosclerosis. People with the metabolic syndrome are
also at higher risk of developing heart failure, a condition
in which the heart is not able to adequately supply the body
with blood.
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What Causes the Metabolic Syndrome?
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The metabolic syndrome is likely the result of multiple metabolic
changes rather than a single cause. The 2 factors most strongly
linked to the metabolic syndrome are abdominal obesity and insulin
resistance. Although the number of people with the metabolic
syndrome has increased over the past 2 decades, our genetic
makeup has not changed. This suggests that contemporary environmental
changes have interacted with our genetic predisposition to store
energy as body fat to produce the metabolic syndrome. The likely
culprits are the progressive increase in food serving sizes,
the expanded number of commercially prepared foods high in salt,
simple sugars, and saturated fats, and the multiple factors
that promote sedentary lifestyles, including the wide variety
of home entertainment options, work-place automation, and reliance
on automobiles.
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What Can I Do to Keep From Developing the Metabolic Syndrome?
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The lifestyle changes recommended for the prevention of the
metabolic syndrome are the same as those recommended for treatment
of the metabolic syndrome, which are described below. People
who are overweight or who have insulin resistance or any one
of these factors should consider adopting lifestyle changes
to prevent development of the metabolic syndrome.
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How Is the Metabolic Syndrome Treated?
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The treatment of the metabolic syndrome is aimed at preventing
the development of atherosclerosis. This is done by treating
the cardiovascular risk factors associated with the syndrome.
The 2 primary treatment approaches are lifestyle changes and
medications. Important lifestyle recommendations are listed
in
Table 2. These lifestyle changes, which include regular exercise,
weight loss, and a diet that is low in salt, sugar, and saturated
fats, are not only good for the heart but also benefit the whole
body. For people who smoke, quitting will provide additional
health benefits and further lower the risk of developing atherosclerosis.
When lifestyle changes are not sufficient or cannot be accomplished, drugs can be prescribed to treat most of the risk factors. There are 4 classes of drugs commonly prescribed for high blood pressure: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, calcium-channel blockers, and beta-blocking agents. Common drugs used for treatment of high low-density lipoprotein (bad) cholesterol, low high-density lipoprotein (good) cholesterol, and high triglycerides include statins and niacin (nicotinic acid). The most common drug prescribed for high blood sugar in people with the metabolic syndrome is metformin. If diabetes is present, additional drugs may be prescribed. The specific drugs that are prescribed will vary depending on a person’s individual health and tolerance of specific drugs. For some people, treatment may require a combination of lifestyle changes and medications.
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Acknowledgments
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Disclosures
None.
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References
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1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
Circulation. 2005; 112: 2735–2752.
[Free Full Text]2. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002; 287: 356–359.[Abstract/Free Full Text]
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