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The metabolic syndrome epidemic
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Posted by editor Sat Apr 8, 2006 10:37:18 PDT
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0 responses 0 comments Metabolic syndrome, also known as syndrome X, is soon to become the leading risk factor for cardiovascular disease worldwide. Smoking has always been considered the leading risk factor for heart disease in the past. However, metabolic syndrome is now being looked upon as the number one risk factor in the new medical literature.

Here is an important statistic from Diabetes Care medical journal: there are nearly 250 million adults worldwide today, 80 percent of whom will die from cardiovascular disease. However, those diabetics who also meet the criteria for metabolic syndrome are at a two-fold risk of dying from a stroke or heart attack than those who do not have the syndrome.

Diagnostic criteria

The diagnostic criteria for metabolic syndrome are as follows:

• Dyslipidemia  (high triglycerides and low HDL)

• Elevated blood pressure

• Central obesity

• High fasting glucose, impaired glucose tolerance, insulin resistance or plain old diabetes mellitus

Nearly half of the population will die from a cardiovascular event. In addition, the leading cause of these cardiovascular conditions is now being recognized as metabolic syndrome, or syndrome X.

According to the data from the Third National Health and Nutritional Survey from 1988 to 1994, 50 million Americans (25 percent of the population in the U.S.) met the diagnostic criteria for metabolic syndrome. The Framingham Heart Study Statistics later confirmed these figures. The Framingham study demonstrated that the metabolic syndrome alone predicted an approximately 25 percent incident of new-onset coronary disease.

Physician and patient awareness

Several years ago, before I met my wife, she went to several doctors and told them that she believes she fit the criteria for metabolic syndrome. She states that doctors looked at her as if she was crazy. Physicians felt offended because she talked about something they had not yet heard about.
Since that time, metabolic syndrome has appeared extensively in medical literature. Interestingly, according to recent medical surveys, physicians continue to be unfamiliar with this condition and often fail to diagnose their patients with this syndrome.

Diagnosing syndrome X

In diagnosing syndrome X, a physician needs to measure abdominal girth. Think of this as a new vital sign. This is for the measurement of central obesity. Measurement should be done at the level of the naval (the belly button). For caucasian women, 35 inches or greater and for caucasian men, 40 inches or greater, would meet the criterion. Although not directly related to metabolic syndrome, weight is important. However, weighing a patient without height is not very meaningful. Use a conversion chart on the wall for body mass index.

As for blood pressure, we have become increasingly aware over recent year the blood pressure of 140/90 is high. We should target for 130-80 or even lower depending on risk factors.

Healthcare providers also need to be educated about patients’ ethnic backgrounds. The definition of central obesity and even HDL may differ from one ethnic group to another and from one race to another. For example, Asian men with abdominal girth of over 35 inches and women over 30 inches would meet the criterion.

As physicians, we need to update ourselves with changing criteria and definitions. Definitions of elevated blood sugar levels have been constantly changing over the years. For example, now we know that fasting sugar over 115 may be high or may be even over 100. Unfortunately, the blood tests for glycemia (sugar levels) are not always very reliable. Reliability of blood tests for gestational diabetes in pregnancy is worse. I cannot tell you how often I have delivered diabetic babies from mothers whose sugar tests were completely normal during their pre-natal care. Moreover, insulin resistance is as serious a problem as diabetes itself as it relates to metabolic syndrome.

Conclusion

Considering the epidemic of metabolic syndrome in the United States, you need to consult your physician if you think you are at risk. Have you physician do the appropriate testing that meets the diagnostic criteria. If you have a family history on top of all the risk factors, I suggest you find a physician who takes keen interest in this area. Considering the fact that you are likely to die from cardiovascular disease rather than anything else, work for this syndrome should be one of the most essential parts of your basic healthcare offered to you by your healthcare provider.

Any questions with regard to metabolic syndrome are welcomed at healtharetoday@hotmail.com/.

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