Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten
10 November 2004

WHAT IS THE METABOLIC SYNDROME?

     A lady recently came to the clinic stating that she had heard on television that people with the metabolic syndrome are more likely to have heart attacks.  She wondered what the metabolic syndrome was and how one could find out if they had it.   First, I pointed out that the metabolic syndrome was a relatively recent term.  It is synonymous with “Syndrome X”, “Dysmetabolic Syndrome” or “the insulin-resistant syndrome”.  These are all older terms but never were picked up very well by the media.  But now radio, television and magazines have adopted the term  “Metabolic Syndrome” and it is written about in many places.

     The Metabolic Syndrome is made up of 5 parts as defined by the National Cholesterol Education Program (NCEP). These 5 components are:
     1.  Abdominal obesity with a waist circumference greater than 40 inches for men or 35 inches for women.
     2.  Increased triglyceride level to greater than 150 mg%.
     3.  A decreased HDL-C level.  For men, the HDL should be greater than 40 mg%, for women it should be greater than 50 mg%.
     4.  High blood pressure (blood pressure greater than 130/85).
     5.  High blood sugars in the fasting state (greater than 110 mg%).

     These 5 abnormalities tend to cluster in individual patients.  Patients are diagnosed as having the Metabolic Syndrome if they have any 3 of the 5 abnormalities.  What this means is that people with the Metabolic Syndrome have a substantially increased risk of heart attack or stroke at a young age.  The problem faced by patients with this syndrome is that they have no symptoms.  Thus the only way to diagnose it is by blood tests.  Men, who are the group most at risk, don’t tend to come to the clinic for preventive medicine, blood tests and care.

     Patients often ask, as the lady above, “What causes the Metabolic Syndrome?”  The answer is that the Metabolic Syndrome is genetically permitted.  There are a large number of individuals who are naturally very thin and maintain their body weight with no effort.  Their triglyceride levels and blood pressure and blood sugars are always normal and it is through no deliberate effort on the person’s part to keep things that way.  There are other individuals who are genetically predetermined not to have that type of weight and blood pressure stability.  Instead, some people have some predisposition to be “easy keepers”.  They tend to eat more than they need and store that energy as fat tissue.  When times were tougher a long time ago, and food was not so plentiful, these individuals had a clear survival benefit.

     But in today’s world, the one fourth of our population that has the Metabolic Syndrome has plentiful foodstuff in very concentrated form.  That genetic predisposition to gain weight is a detriment instead of a survival benefit.  As patients accumulate fatty tissue, they become resistant to their own insulin and this creates the Metabolic Syndrome.  The reason that weight gain leads to insulin resistance is not known.  It is a genetic trait that is unmasked by the weight gain.  The insulin resistance then generates the high blood pressure and the lipid abnormalities that complete the Metabolic Syndrome.

    The lady who asked the question above then inquired about what she could do to deal with the Metabolic Syndrome that she, her husband and her son had.  She acknowledged that she had worked on weight gain but she had great difficulty controlling her weight as did the other members of her family.  In the absence of adequate weight control, there are medications that can help correct some of the aspects of the Metabolic Syndrome.  There are blood pressure pills that can bring the blood pressure down in the normal range and these have been shown to be highly effective in preventing strokes and heart attacks.  There are lipid pills that can get the triglyceride level down and the HDL (good cholesterol) up into the normal range.  These medications include the statin family of drugs, niacin, gemfibrozil, Tricor, and several other lesser-used products.  There are medications that can help correct the high blood sugars that come with the Metabolic Syndrome. These medications help correct the insulin resistance that is the root of the problem.

    The lady was thus told that there is a very depressing solution if weight control doesn’t work. That is a person can take 3 different medications to try and get the abnormalities of the Metabolic Syndrome corrected.  With the high cost of medications, you can see that weight control is a whole lot cheaper and in fact more effective.  Monitoring a person’s blood pressure, high blood lipids, and blood sugars can be done through your local clinic.  The healthcare providers at your local clinics are well aware of the problems of the Metabolic Syndrome and its unfortunate consequences if not effectively treated.