What is Metabolic Syndrome?

Metabolic Syndrome is a cluster of interconnected metabolic abnormalities that significantly increase the risk of cardiovascular disease, type 2 diabetes, stroke, and fatty liver disease. It's not a single disease but rather a constellation of risk factors that occur together.

Diagnostic Criteria:

Metabolic Syndrome is diagnosed when a person has 3 or more of the following 5 criteria:

• 1. Abdominal Obesity (Central Obesity):
  • Waist circumference >40 inches (102 cm) in men
  • Waist circumference >35 inches (88 cm) in women
• 2. Elevated Triglycerides:
  • ≥150 mg/dL or on medication for high triglycerides
• 3. Low HDL Cholesterol ("Good" Cholesterol):
  • <40 mg/dL in men or on medication
  • <50 mg/dL in women or on medication
• 4. Elevated Blood Pressure:
  • Systolic ≥130 mmHg and/or Diastolic ≥85 mmHg or on blood pressure medication
• 5. Elevated Fasting Glucose:
  • ≥100 mg/dL or on medication for diabetes

How Common is it?

• Affects approximately 1 in 3 adults in the United States
• Prevalence increases with age and obesity rates
• More common in certain ethnic groups (Hispanic, Native American, Asian populations)

What Causes Metabolic Syndrome?

The underlying drivers are:

• Insulin Resistance (Main Driver): Body's cells don't respond properly to insulin → high insulin levels → metabolic abnormalities
• Obesity (Especially Visceral/Abdominal Fat): Fat around organs releases inflammatory substances and hormones that worsen insulin resistance
• Sedentary Lifestyle
• Genetics: Family history of diabetes, high blood pressure, high cholesterol
• Aging
• Hormonal Factors: PCOS, Cushing's syndrome

Health Risks:

• Cardiovascular Disease: 2-3x increased risk of heart attack, stroke
• Type 2 Diabetes: 5x increased risk
• Fatty Liver Disease (NAFLD/NASH): Can progress to cirrhosis
• Chronic Kidney Disease
• Sleep Apnea
• Certain Cancers: Colon, breast, endometrial
• Cognitive Decline/Dementia

Symptoms:

Most components of metabolic syndrome are asymptomatic ("silent") until complications develop. However, you may notice:

• Increased waist size, abdominal obesity
• Acanthosis nigricans (dark, velvety skin patches in neck/armpits—sign of insulin resistance)
• Skin tags
• Fatigue, low energy
• Symptoms of diabetes (thirst, frequent urination) if glucose very high

Diagnosis:

Physical Exam:

• Measure waist circumference
• Blood pressure
• BMI, weight

Labs:

• Fasting Glucose or HbA1c
• Lipid Panel: Total cholesterol, LDL, HDL, triglycerides
• Additional Tests (to assess risk/complications):
• Fasting insulin (assess insulin resistance)
• Liver enzymes (ALT, AST—check for fatty liver)
• Kidney function (creatinine, eGFR)
• Uric acid (often elevated)
• hsCRP (inflammatory marker)

Treatment:

Goal: Reduce cardiovascular risk and prevent diabetes

1. Lifestyle Modifications (CORNERSTONE):

Weight Loss:

• Even modest weight loss (5-10% of body weight) dramatically improves all components
• Focus on reducing abdominal/visceral fat

Diet:

• Mediterranean Diet: Emphasize fruits, vegetables, whole grains, lean protein, healthy fats (olive oil, nuts, fish)
• DASH Diet: For blood pressure control
• Limit refined carbs, sugars, processed foods
• Reduce saturated fats, trans fats
• Increase fiber

Exercise:

• Aerobic Exercise: 150+ minutes/week (brisk walking, swimming, cycling)
• Resistance Training: 2-3 days/week (builds muscle, improves insulin sensitivity)
• Reduce sedentary time (stand up every hour)

Quit Smoking, Limit Alcohol

2. Medications (Treat Individual Components):

For High Blood Pressure:

• ACE inhibitors, ARBs (improve insulin sensitivity)
• Thiazide diuretics, calcium channel blockers

For Dyslipidemia (High Cholesterol/Triglycerides):

• Statins: Lower LDL and reduce cardiovascular risk
• Fibrates: Lower triglycerides (fenofibrate, gemfibrozil)
• Omega-3 Fatty Acids: For high triglycerides

For High Glucose/Prediabetes/Diabetes:

• Metformin: Improves insulin sensitivity; prevents diabetes in high-risk patients
• GLP-1 Agonists: For weight loss and glucose control (semaglutide, tirzepatide)
• SGLT2 Inhibitors: Lower glucose, promote weight loss, protect heart/kidneys

For Obesity:

• GLP-1 Agonists: Semaglutide (Wegovy®), tirzepatide (Zepbound®)
• Bariatric Surgery: For severe obesity (BMI ≥40 or ≥35 with comorbidities)—highly effective

3. Aspirin (Low-Dose):

• May be recommended for primary prevention of cardiovascular disease in high-risk patients
• Discuss with doctor (benefits vs. bleeding risk)

Monitoring:

• Every 3-6 Months:
  • Weight, waist circumference, BMI
  • Blood pressure
  • Fasting glucose or HbA1c
  • Lipid panel
• Liver Function: Annually (if fatty liver suspected)
• Kidney Function: Annually
• Cardiovascular Risk Assessment: Calculate 10-year ASCVD risk score

Prognosis:

• Metabolic Syndrome is REVERSIBLE with lifestyle changes
• Even small improvements (weight loss, exercise) reduce cardiovascular risk significantly
• Untreated, it progresses to diabetes and cardiovascular disease