METABOLIC SYNDROME, A NEW DISEASE?



Physicians and increasingly the public have appreciated that an elevated cholesterol level, hypertension, and diabetes are risk factors for the development of cardiovascular disease. Health organizations across the country have been discussing the importance of treatment for these conditions.

Only in the recent years has it become apparent that a constellation of lesser abnormalities on testing and exam is often associated with the future development of diabetes, heart attacks, hypertension, and premature death. This constellation is called the Metabolic Syndrome, also known as Syndrome X, or Insulin Resistance Syndrome.

The Metabolic Syndrome is diagnosed when three of the following conditions are present in a person:
1. Insulin Resistance, as defined by mild fasting blood sugar elevation and an abnormal glucose tolerance test.
2. Hypertension, blood pressure above 130/85 mm Hg.
3. Elevated cholesterol or triglyceride levels.
4. Heart disease, for example coronary heart disease.
5. Abdominal obesity: a waist circumference greater than 40 inches in men and greater than 35 inches in women.

Studies have shown that the risk of death is increased over five times normal when the metabolic syndrome is present. One of the major effects of the Syndrome is what has been called ‘insulin resistance.’ Insulin resistance refers to the body’s impaired capacity to utilize insulin in its normal way. The effect of insulin is impaired and the body attempts to compensate by producing more insulin. At the same time blood sugar builds up and rises to elevated levels which are typically not in the diabetic range but eventually may rise to the diabetic range in some persons. High insulin levels are detrimental to the body. Such high levels have been shown to raise cholesterol and triglyceride levels, and they contribute to hypertension and the development of diabetes and obesity. The presence of fat in the abdomen is associated with an increased propensity of the blood to clot and with an increased inflammatory state, which is associated with a higher risk of suffering an acute heart attack.

The presence of the Metabolic Syndrome leads to disease, early disability, and premature death. The Syndrome is a precursor to Type II diabetes and to acute cardiovascular illness including heart attack and strokes.

The causes of the Metabolic Syndrome are complex and in many ways they relate to the way we live and particularly the way we eat in our modern society. We consume a diet rich in refined carbohydrates. Our diet includes many refined bread products, baked goods, many processed foods and too much fast food. Our diet is also rich in saturated fats and processed fats. In addition to eating the wrong kinds of foods we tend to eat too much food as well. Furthermore, our lifestyle tends to become progressively more sedentary and inactive as we grow in age. Even though we tend to grow less active we don’t seem to consume fewer calories, as we grow older.

In order to prevent the Metabolic Syndrome from developing, a lifestyle change that includes more physical activity and a change of dietary habits are necessary. In addition treatment of medical conditions associated with the Metabolic Syndrome is also required.

Cornerstones of treatment of the metabolic syndrome include
1. Management of blood pressure to achieve a goal of 130/80 mm Hg or lower.
2. Treatment of obesity with dietary changes and reduction of calories consumed, avoiding fast foods and often reducing the intake of carbohydrates.
3. Increased physical activity improves many underlying factors active in the Metabolic Syndrome.
4. Dietary and medical treatment of abnormal cholesterol and triglyceride levels.

Many articles have been published recently about the epidemic of obesity in the United States and other Western countries. It is easy to understand that an increase in obesity leads to an increase of the presence of the Metabolic Syndrome. This in turn leads to an increase in the occurrence of diabetes and cardiovascular disease. Studies on the Metabolic Syndrome tell us that even mild to moderate obesity may be associated with an increased risk for diabetes and cardiovascular disease later in life.

I encourage you as the reader to discuss the possible presence of the Metabolic Syndrome with your doctor. Knowing whether you have The Metabolic Syndrome may provide you with the information necessary to make some important changes in your life to enhance your future health.

Georg Emlein, MD, FACC is affiliated with the Sacramento Heart & Vascular Medical Associates located in the Sacramento Heart Center. For more information about the Sacramento Heart & Vascular Medical Associates, visit their website at www.sacheart.com or call (916) 830-2000 and request information be mailed to you. Please address your cardiology-related questions to "Ask the Cardiologist", 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future columns.