Metabolic Syndrome:
Increasing Awareness

Metabolic syndrome is an important and relatively common condition that can affect both men and women. The prevalence of metabolic syndrome among US women increased by 24% between 1988-1994 and 1999-2000.1 The presence of the metabolic syndrome may be a predictor of cardiovascular disease that could require monitoring.2,3 (SOR: A) In this issue of Know Her Heart, you will learn about the association between metabolic syndrome and heart disease and how to identify this condition in your patients.



What Is Metabolic Syndrome?

Metabolic syndrome (also called syndrome X and insulin resistance syndrome) is a condition that comprises a cluster of risk factors, including2:

• Abdominal obesity
• Atherogenic dyslipidemia (elevated triglycerides, small LDL particles, low HDL cholesterol)
• Raised blood pressure
• Insulin resistance or glucose intolerance (type 2 diabetes)
• Prothrombotic state (eg, increased fibrinogen or plasminogen activator inhibitor-1 blood level)
• Proinflammatory state (eg, elevated high-sensitivity C-reactive protein blood level)

• In the Framingham Heart Study, the presence of metabolic syndrome alone predicted almost 25% of all new-onset cardiovascular disease.2
• Metabolic syndrome is also associated with a 3.0- to 4.3-fold increased risk for coronary heart disease mortality.3
• Women with metabolic syndrome are generally less active and have lower cardiovascular fitness levels than women without metabolic syndrome.4,5
• Eighty-four percent of metabolic syndrome patients are obese, and there may be a direct correlation between the rising obesity problem and the increasing incidence of metabolic syndrome.6,7

Identifying the Patient With Metabolic Syndrome

The diagnosis of metabolic syndrome is made by the presence of 3 of the 5 risk factors below.8

Adapted from Circulation. 2002;106:3143-3421.

*Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated BMI. Therefore, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome.

†Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, eg, 37 in to 39 in (94 cm to 102 cm). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from changes in life habits, similarly to men with categorical increases in waist circumference.

‡The American Diabetes Association has recently established a cutpoint of >100 mg/dL, above which persons have either prediabetes (impaired fasting glucose) or diabetes.1 This new cutpoint should be applicable for identifying the lower boundary to define an elevated glucose as one criterion for the metabolic syndrome.

References
1. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes Care. 2004;27:2444-2449. 2. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004;109:433-438. 3. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709-2716. 4. Irwin ML, Ainsworth BE, Mayer-Davis EJ, Addy CL, Pate RR, Durstine JL. Physical activity and the metabolic syndrome in a tri-ethnic sample of women. Obes Res. 2002;10:1030-1037. 5. Farrell SW, Cheng YJ, Blair SN. Prevalence of the metabolic syndrome across cardiorespiratory fitness levels in women. Obes Res. 2004;12:824-830. 6. Jacobson TA, Case CC, Roberts S, et al. Characteristics of US adults with the metabolic syndrome and therapeutic implications. Diabetes Obes Metab. 2004;6:353-362. 7. 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. 8. National Institutes of Health. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Circulation. 2002;106:3143-3421

April 2005

In an effort to bring more personal service to our patients we are moving our billing services in house. This means that for those who have outstanding balances prior to April 1st, will probably recieve two billing statements, one from AOK Billing, and one from the office.

In order to help Lisa with the new responsilbilities of moving the billing in house, Cheryl will now be working on billing, and we have hired a new receptionist, Jennifer who will be starting on April 18th.

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May Newsletter

Vascular Disease Presentation

Spring Newsletter

Winter Newsletter

July Newsletter