If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
When medical professionals use the word syndrome, we are generally describing a group of interrelated problems. In the case of metabolic syndrome (MetS), we’re referring to a cluster of different disease processes that, together, make people sick and increase their long-term risk of serious illness.
Risk factors associated with metabolic syndrome are excess belly fat, high triglycerides, a low level of “good” HDL cholesterol, and insulin resistance. (Insulin resistance is synonymous with pre-diabetes, when the pancreas is producing adequate insulin but the body is becoming resistant to it, leading to excess sugar in the bloodstream.)
Specifically, metabolic syndrome is diagnosed when a patient displays three or more of these five metabolic syndrome risk factors:
- A waist circumference greater than 40 inches/102 cm in men or 35 inches/89 cm in women
- Blood pressure exceeding 130/85
- A fasting triglyceride level over 150
- A fasting HDL cholesterol at less than 40 in men or 50 in women
- Fasting blood sugar over 100 milligrams per deciliter of blood (after an eight-hour fast)
These conditions are interrelated and, in combination, grow even more serious and complex. Because they contribute significantly to the risk of coronary artery disease, they increase the potential for heart attack and stroke, particularly when there is a family history of heart disease.
Metabolic syndrome is a combination of risk factors that can cause stroke, heart attack, or other serious conditions. But with the right treatment, it can be controlled, even reversed. More from Dr. Meeta Sharma. https://bit.ly/3bhN9VU via @MedStarWHC
Numbers only tell part of the story. Even without most of the risk factors above, a patient may present with metabolic syndrome, depending on build, ethnicity, and family history. For example, a slightly built male of southern Asian heritage may have this disorder despite a waistline of less than 40 inches.
It’s important to consult a medical professional if blood pressure and routine blood work fall outside recommended ranges. And, although the classic definition of metabolic syndrome specifies three or more warning signs, I tend to be more preemptive. If I see a patient with two indicators, I begin the process of education and intervention, since it’s likely he or she will develop a third or fourth factor over time if action isn’t taken.
Besides increasing the patient’s risk of heart attack and stroke, additional imbalances significantly increase their odds of type 2 diabetes and fatty liver disease—disease conditions that are far better to prevent than to treat.
So, whenever we notice a patient’s risk factors increasing, we act quickly and proactively.
Among the most significant risk factors for metabolic syndrome is age—risk is 40 percent higher after age 65 than it is in younger patients. African Americans are also at higher risk, as are Latina women. Diabetes during pregnancy can also increase a patient’s risk.
I consider acanthosis nigricans a signal of metabolic syndrome—it causes dark velvety lesions in skin folds, such as at the neck, armpits, or groin.
But these examples represent only a small percentage of causes. Most instances of MetS are the result of unhealthy lifestyle: excess weight, lack of exercise, and eating poorly. Our Western lifestyle tends to be more sedentary. We work and play at the computer, watch more TV, and eat more processed foods with more fat, sugar, and salt than our parents and grandparents ever did. It’s not surprising that as many as one-third of Americans have metabolic syndrome.
And as obesity and Western habits have spread globally, so have type 2 diabetes and metabolic syndrome. They are both on the rise in Europe, Asia, and the Middle East, with Africa expected to “catch up” quickly. Without intervention, MetS has the potential to be a global epidemic.
We all have risk factors, such as family history, that we cannot change. But most of us can work to control weight, diet, and exercise. It’s not necessarily easy, but it is possible—and potentially life-saving.
At MedStar Washington Hospital Center, we are always on the lookout for early-warning signs of metabolic syndrome in our patients. In the clinic, we begin with a thorough family history and physical exam. The potential for metabolic syndrome often becomes clear when we uncover heart disease, diabetes, obesity, or even gout, another potential predictor, in the family history. All my medical students carry a measuring tape to measure waist size, a primary indicator.
When we suspect MetS, we prescribe blood work and a urine test to provide confirmation. Then, our first step is patient education. Because many of my metabolic syndrome patients feel fine and are living their lives without symptoms or problems, it can be difficult for them to accept that they’re potentially in medical trouble. But most of them have moderate or high risk.
We have tools on hand to help, such as a cardiovascular disease risk calculator that can predict the risk of atherosclerosis and heart disease within the next 10 years. This can be quite an eye-opener for the patient.
Fortunately, most patients know that controlling blood pressure, sugar, and weight benefit their health and understand the need to improve their situation. We typically start with lifestyle changes, like these, that help reduce cholesterol and blood pressure:
- Increase physical activity. I recommend 30 to 60 minutes of aerobic exercise five days per week. On the other two days, practice some form of resistance exercise.
- To normalize blood sugar, adopt a carbohydrate-consistent meal plan, high in whole grains, greens, salads, and legumes.
- To help with weight loss and reduced cholesterol, carbohydrates should make up less than 50 percent of everything you eat and drink. Total fat should be less than 30 percent of the diet; saturated fats from meat, cheese, butter, and other animal products, less than 7 percent.
- Reduce salt intake, which is critical for those with high blood pressure.
- Quit smoking, which also contributes to cardiovascular disease.
Diet and exercise can bring dramatic improvement in MetS—even moderate weight loss can go a long way. Losing just 7 to 10 percent of body weight in the first year has a huge impact on a patient’s total risk.
For patients who are unable to make enough difference via lifestyle changes, we consider medications, both for blood pressure and cholesterol. We carefully assess risk for each individual and introduce medication prudently, depending on the results of the patient’s other efforts.
How MedStar Washington Hospital Center Can Help
Our Endocrinology department is well equipped to help patients get metabolic syndrome under control.
Our doctors are among the best in the country. Each patient has access to an entire multi-disciplinary team of doctors, diabetes educators, and nurse practitioners, all working to educate, support, and motivate. And, because metabolic syndrome can lead to other issues, we collaborate with other specialists, such as cardiologists, to keep the heart and arteries healthy. We also have superb specialists in surgical intervention for weight loss, if that measure is called for.
Care During COVID-19
For some time, we’ve suspected that the presence of metabolic syndrome may increase the severity of COVID-19. Research data have confirmed those suspicions: the factors that contribute to metabolic syndrome are also COVID-19 risks.
Having the disorder doesn’t necessarily make you more likely to contract the coronavirus, but it can make the virus significantly worse once infection sets in. Studies show that metabolic syndrome patients are at higher risk for hospitalization, ICU admission, intubation, and death from COVID. This brings even greater urgency to get MetS under control.
Unfortunately, the current pandemic has made it easier for all of us to fall back into old habits and let our diet and exercise regimens slip. Many people find that they’re not as active and have increased their snacking. Many have delayed visits to their physician.
But remember, the threat of metabolic syndrome can double your risk of cardiovascular disease. Diabetes increases your risk five-fold.
It’s critical to stay vigilant, stay on your diet, stay active, and stay in touch with your doctor.