Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.

The term "metabolic" refers to the biochemical processes involved in the body's normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

Coronary heart disease (CHD) is a condition in which a waxy substance called plaque builds up inside the coronary (heart) arteries. Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.

You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome. Risk factors may include:

• Excess fat in the stomach area
• High blood triglyceride levels
• Low HDL cholesterol levels
• High blood pressure
• High fasting blood glucose 

In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome.

Metabolic syndrome is becoming more common due to a rise in obesity rates among adults. In the future, metabolic syndrome may overtake smoking as the leading risk factor for heart disease.

It is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes.

Most of the metabolic risk factors have no signs or symptoms, although a large waistline is a visible sign.

Some people may have symptoms of high blood sugar if diabetes—especially type 2 diabetes—is present. Symptoms of high blood sugar often include increased thirst; increased urination, especially at night; fatigue (tiredness); and blurred vision.

High blood pressure usually has no signs or symptoms. However, some people in the early stages of high blood pressure may have dull headaches, dizzy spells, or more nosebleeds than usual.

Metabolic syndrome has several causes that act together. You can control some of the causes, such as overweight and obesity, an inactive lifestyle, and insulin resistance.

You can't control other factors that may play a role in causing metabolic syndrome, such as growing older. Your risk for metabolic syndrome increases with age.

You also can't control genetics (ethnicity and family history), which may play a role in causing the condition. For example, genetics can increase your risk for insulin resistance, which can lead to metabolic syndrome.

People who have metabolic syndrome often have two other conditions: excessive blood clotting and constant, low-grade inflammation throughout the body. Researchers don't know whether these conditions cause metabolic syndrome or worsen it.

Researchers continue to study conditions that may play a role in metabolic syndrome, such as:

• A fatty liver (excess triglycerides and other fats in the liver)
• Polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)
• Gallstones
• Breathing problems during sleep (such as sleep apnea)

People at greatest risk for metabolic syndrome have these underlying causes:

• Abdominal obesity (a large waistline)
• An inactive lifestyle
• Insulin Resistance

Some people are at risk for metabolic syndrome because they take medicines that cause weight gain or changes in blood pressure, blood cholesterol, and blood sugar levels.

These medicines most often are used to treat inflammation, allergies, HIV, and depression and other types of mental illness.

Populations Affected

Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally.

Some racial and ethnic groups in the United States are at higher risk for metabolic syndrome than others. Mexican Americans have the highest rate of metabolic syndrome, followed by Whites and African Americans.

Worldwide, certain ethnic groups, such as South Asians, are at increased risk for metabolic syndrome.

Other groups at increased risk for metabolic syndrome include:

• People who have a sibling or parent who has diabetes
• People who have a personal history of diabetes
• Women who have a personal history of polycystic ovarian syndrome (a tendency to develop cysts on the ovaries)

Heart Disease Risk

Metabolic syndrome increases your risk for heart disease. Heart disease risk can be divided into short-term risk and long-term risk.

"Short-term risk" refers to the risk of having a heart attack or dying from heart disease in the next 10 years. "Long-term risk" refers to the risk of developing heart disease over your lifetime.

Other risk factors, besides metabolic syndrome, also increase your risk for heart disease. For example, a high LDL cholesterol level and smoking are major risk factors for heart disease. 

Your doctor will diagnose metabolic syndrome based on the results of a physical exam and blood tests. You must have at least three of the five metabolic risk factors to be diagnosed with metabolic syndrome.

Metabolic Risk Factors

A Large Waistline - Having a large waistline means that you carry excess weight around your waist (abdominal obesity). This is also called having an "apple-shaped" figure. Your doctor will measure your waist to find out whether you have a large waistline. A waist measurement of 35 inches or more for women or 40 inches or more for men is a metabolic risk factor. A large waistline means you're at increased risk for heart disease and other health problems.

A High Triglyceride Level - Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is milligrams per deciliter—the units used to measure triglycerides, cholesterol, and blood sugar.)

A Low HDL Cholesterol Level - HDL cholesterol sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. An HDL cholesterol level of less than 50 mg/dL for women and less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol) is a metabolic risk factor.

High Blood Pressure - A blood pressure of 130/85 mmHg or higher (or being on medicine to treat high blood pressure) is a metabolic risk factor. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If only one of your two blood pressure numbers is high, you're still at risk for metabolic syndrome.

High Fasting Blood Sugar - A normal fasting blood sugar level is less than 100 mg/dL. A fasting blood sugar level between 100–125 mg/dL is considered prediabetes.

• A fasting blood sugar level of 126 mg/dL or higher is considered diabetes.
• A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar) is a metabolic risk factor.

About 85 percent of people who have type 2 diabetes—the most common type of diabetes—also have metabolic syndrome. These people have a much higher risk for heart disease than the 15 percent of people who have type 2 diabetes without metabolic syndrome.

Making healthy lifestyle choices is the best way to prevent metabolic syndrome. One important lifestyle choice is to maintain a healthy weight. Other than weighing yourself on a scale, you can find out if you're at a healthy weight using your waist measurement and body mass index (BMI).

A waist measurement indicates your abdominal fat, which is linked to your risk for heart disease and other diseases. To measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't squeeze the flesh.

A waist measurement of less than 35 inches for women and less than 40 inches for men is the goal for preventing metabolic syndrome; it's also the goal when treating metabolic syndrome.

BMI measures your weight in relation to your height and gives an estimate of your total body fat.

• A BMI between 25 and 29.9 is considered overweight.
• A BMI of 30 or more is considered obese.
• A BMI of less than 25 is the goal for preventing metabolic syndrome; it's also the goal when treating metabolic syndrome.

To maintain a healthy weight, follow a heart healthy diet and try not to overeat. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

Being physically active also can help you maintain a healthy weight. Before starting any kind of exercise program or new physical activity, talk with your doctor about the types and amounts of physical activity that are safe for you.

Make sure to schedule routine doctor visits to keep track of your cholesterol, blood pressure, and blood sugar levels. A blood test called a lipoprotein panel will show your levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Living with Metabolic Syndrome

Metabolic syndrome is a lifelong condition. However, lifestyle changes can help you control your risk factors and reduce your risk for heart disease and diabetes.

If you already have heart disease and/or diabetes, lifestyle changes can help you prevent or delay related problems. Examples of these problems include heart attack, stroke, and diabetes-related complications (for example, damage to your eyes, nerves, kidneys, feet, and legs).

Lifestyle changes may include losing weight, following a heart healthy diet, being physically active, and quitting smoking.

If lifestyle changes aren't enough, your doctor may recommend medicines. Take all of your medicines as your doctor prescribes. 

Make realistic short- and long-term goals for yourself when you begin to make healthy lifestyle changes. Work closely with your doctor and seek regular medical care.

Healthy lifestyle changes are the first line of treatment for metabolic syndrome. Lifestyle changes include losing weight, being physically active, following a heart healthy diet, and quitting smoking.

If lifestyle changes aren't enough, your doctor may prescribe medicines. Medicines are used to treat and control risk factors such as high blood pressure, high triglycerides, low HDL cholesterol, and high blood sugar.

Blood-thinning medicines, such as aspirin, also may be used to reduce the risk of blood clots. Excessive blood clotting is a condition that often occurs with metabolic syndrome.

Goals of Treatment

The major goal of treating metabolic syndrome is to reduce the risk of heart disease. Treatment is directed first at lowering LDL cholesterol and high blood pressure and managing diabetes (if these conditions are present).

The second goal of treatment is to prevent the onset of type 2 diabetes (if it hasn't already developed). Long-term complications of diabetes often include heart and kidney disease, vision loss, and foot or leg amputation.

If diabetes is present, the goal of treatment is to reduce your risk for heart disease by controlling all of your risk factors.

The main focus of treating metabolic syndrome is managing the risk factors that are within your control, such as overweight or obesity, an unhealthy diet, and an inactive lifestyle.

Lifestyle Changes

Losing Weight

If you have metabolic syndrome and are overweight or obese, your doctor will likely recommend weight loss. He or she can help you create a weight-loss plan and goals. 

The long-range target is to lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat.

A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for prevention and treatment of metabolic syndrome.

Following a Heart Healthy Diet

A heart healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits.

A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. 

Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, such as soda.

Also, try to limit the amount of solid fats and refined grains that you eat. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

If you drink alcohol, do so in moderation. Too much alcohol can raise your blood pressure and triglyceride level. Alcohol also adds extra calories, which can cause weight gain.

Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in from food and drinks with the calories you use while doing physical activity.

Being Physically Active

Physical activity can help keep your heart and lungs healthy. Many Americans are not active enough. The good news is that even modest amounts of physical activity are good for your health. The more active you are, the more you'll benefit.

Before starting any kind of exercise program or new physical activity, talk with your doctor about the types and amounts of physical activity that are safe for you.

The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching.

You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity. People who have metabolic syndrome usually are urged to keep up a moderate level of activity.

Smoking

If you smoke, quit. Smoking can raise your risk for heart disease and heart attack and worsen other heart disease risk factors. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

Medicines

If lifestyle changes aren't enough, your doctor may prescribe medicines to help you control your risk factors. Medicines can help treat unhealthy cholesterol levels, high blood pressure, and high blood sugar.

Unhealthy cholesterol levels are treated with medicines such as statins, fibrates, or nicotinic acid.

High blood pressure is treated with medicines such as diuretics or ACE inhibitors.

High blood sugar is treated with oral medicines (such as metformin), insulin injections, or both.

Low-dose aspirin can help reduce the risk of blood clots, especially for people whose risk of heart disease is high.