Mentor: Laurie S. Swaim, MD
Editor: Paula J. Hillard, MD
The metabolic syndrome encompasses a cluster of risk factors including central obesity, dyslipidemia, elevated blood pressure, and hyperglycemia. Together these factors increase the risk of atherosclerotic cardiovascular disease and type 2 diabetes. Developing the metabolic syndrome is associated with elevated body mass index (BMI), sedentary lifestyle, low socioeconomic status and advancing age. Due to the increasing prevalence of obesity in the United States, metabolic syndrome is a common problem. As of 2012, approximately 35% of adult women in the United States met criteria for the syndrome, with white non-Hispanic women having the highest incidence.
There are several definitions for the metabolic syndrome, with the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) the most commonly used. Based on the NCEP ATP III criteria, clinical diagnosis in women relies on the fulfillment of at least three of the following criteria:
- HDL cholesterol < 50 mg/dL or drug therapy for low HDL cholesterol
- Waist circumference > 88 cm (35 in)
- Systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 85, or drug therapy for hypertension
- Fasting plasma glucose ≥ 100 mg/dL, drug therapy for hyperglycemia, or previously diagnosed type 2 DM
- Triglyceride level > 150 mg/dL or drug therapy for elevated triglycerides
More recent revisions to the definition validate these criteria but also call for ethnic, regional, and country specific values for elevated waist measurement.
The most accepted theory to describe the underlying cause of the metabolic syndrome is insulin resistance. Metabolic syndrome is a predictor for cardiovascular disease and type 2 diabetes. Once disease develops, the individual components promote disease progression. There are typically no associated symptoms; however nonalcoholic fatty liver disease, hyperuricemia, polycystic ovarian syndrome, and obstructive sleep apnea may coexist due to shared risk factors.
Weight reduction, increased physical activity, and behavior modification are the mainstays of therapy. A weight loss of 5-10% over 6 to 12 months through reduced caloric intake and moderate intensity exercise on most days of the week is recommended. Diets with an emphasis on fruits, vegetables, fish, and whole grains and restricted in saturated and trans-fats are recommended. Exercise may have additional benefits beyond its effect on weight loss by selectively removing abdominal fat. In some patients, treatment beyond lifestyle modification is required and may include weight-loss medications or bariatric surgery. Typically, surgery is an option for patients who have a BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Cardiovascular risk factors and diabetes should be treated with pharmacologic therapy if they persist despite weight loss and lifestyle modification.
American Heart Association; National Heart, Lung, and Blood Institue, Grundy SM, et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiol Rev. 2005 Nov-Dec;13(6):322-7. PMID: 16708441
Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988-2012. Prev Chronic Dis. 2017 Mar 16;14:E24. doi: 10.5888/pcd14.160287.
Initial approval: January 2014; Revised September 2018
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