Clinical Background
Metabolic Syndrome is a cluster of cardiovascular factors which may indicate an increased risk for developing cardiovascular disease (CVD) and diabetes.
Epidemiology
- Incidence - 40-50 million people in the U.S.
- Age - increased incidence with age
- Low incidence in persons <30 years old
- greater than or equal to 50% incidence in persons >60 years old
- Sex - equal between males and females
Risk Factors
- Abdominal obesity
- Polycystic Ovarian Syndrome (PCOS)
- Older age
- Insulin resistance
- Genetics
Pathophysiology
- Insulin resistance is thought to represent most of the underlying pathophysiology
- Development of obesity and physical inactivity lead to insulin resistance
- Proinflammatory and prothrombotic state with glucotoxicity and lipotoxicity contributes to metabolic and vascular abnormalities
Clinical Presentation
- Obesity
- Diabetes
- Hyperlipidemia
- Hypertension
Treatment
- Blood pressure reduction measures
- Diet and exercise with weight loss
- May require antihypertensives and lipid lowering agents
See Also
Diagnosis
Diagnosis
- Definition (requires 3 of 5 criteria) National Cholesterol Education Program ATP III
- Waist circumference greater than or equal to 40 inches (men); greater than or equal to 35 inches (women)
- Triglyceride level greater than or equal to 150 mg/dL
- HDL <40 mg/dL (men); <50 mg/dL (women)
- Hypertension (BP greater than or equal to 130/85)
- Fasting blood glucose greater than or equal to 100 mg/dL
Refer to Metabolic Syndrome topic at www.arupconsult.com for additional information about the chart of Criteria for Major Definitions of the Metaoblic Syndrome
- Laboratory testing
- Fasting Blood Sugar
- Lipid Panel
Tests generally appear in the order most useful for common clinical situations
| Test name: Lipid Panel
|
| ARUP #: 0020421 |
| Methodology: Refer to individual components
|
| Use: Determine cardiovascular risk |
| Limitations: |
| Follow-up:
|
| Test name: Lipid Panel, Extended
|
| ARUP #: 0020468 |
| Methodology: Refer to individual components
|
| Use: Determine cardiovascular risk |
| Limitations: |
| Follow-up:
|
| Test name: Glucose Tolerance Test
|
| ARUP #: 0020542 |
| Methodology: Enzymatic
|
| Use: Determine diabetic risk |
| Limitations: |
| Follow-up:
|
| Test name: Glucose, Plasma or Serum
|
| ARUP #: 0020024 |
| Methodology: Enzymatic
|
| Use: Determine diabetic risk |
| Limitations: |
| Follow-up:
|
References
Cited References
Jain P, Lahiri A. Metabolic syndrome: an evolving threat in the genesis of coronary artery disease. J Cardiometab Syndr.
2007;
2(
3):
190-197.
General References
Brietzke SA. Controversy in diagnosis and management of the metabolic syndrome. Med Clin North Am.
2007;
91(
6):
1041-viii.
Cooper-DeHoff RM, Pepine CJ. Metabolic syndrome and cardiovascular disease: challenges and opportunities. Clin Cardiol.
2007;
30(
12):
593-597.
Cussons AJ, Stuckey BG, Watts GF. Metabolic syndrome and cardiometabolic risk in PCOS. Curr Diab Rep.
2007;
7(
1):
66-73.
Desroches S, Lamarche B. The evolving definitions and increasing prevalence of the metabolic syndrome. Appl Physiol Nutr Metab.
2007;
32(
1):
23-32.
Fernandez ML. The metabolic syndrome. Nutr Rev.
2007;
65(
6 Pt 2):
S30-S34.
James WP, Rigby N, Leach R. Obesity and the metabolic syndrome: the stress on society. Ann N Y Acad Sci.
2006;
1083:
1-10.
Johnson LW, Weinstock RS. The metabolic syndrome: concepts and controversy. Mayo Clin Proc.
2006;
81(
12):
1615-1620.
Pi-Sunyer X. The metabolic syndrome: how to approach differing definitions. Med Clin North Am.
2007;
91(
6):
1025-40, vii.
Pratley RE. Metabolic syndrome: why the controversy?. Curr Diab Rep.
2007;
7(
1):
56-59.
Schwarz PE, Reimann M, Li J, Bergmann A, Licinio J, Wong ML, Bornstein SR. The Metabolic Syndrome - a global challenge for prevention. Horm Metab Res.
2007;
39(
11):
777-780.
Sharma V, McNeill JH. The etiology of hypertension in the metabolic syndrome part four: the systemic perspective--the role of the neuroendocrine and immune systems, and the challenge of integration. Curr Vasc Pharmacol.
2006;
4(
4):
349-381.
Sharma V, McNeill JH. The etiology of hypertension in the metabolic syndrome part one: an introduction to the history, the concept and the models. Curr Vasc Pharmacol.
2006;
4(
4):
293-304.
Sharma V, McNeill JH. The etiology of hypertension in the metabolic syndrome part three: the regulation and dysregulation of blood pressure. Curr Vasc Pharmacol.
2006;
4(
4):
321-348.
Sharma V, McNeill JH. The etiology of hypertension in the metabolic syndrome part two: the gene-environment interaction. Curr Vasc Pharmacol.
2006;
4(
4):
305-320.
Medical Reviewers
Roberts, William L. , M.D., Ph.D. Medical Director, Automated Core Laboratory at ARUP Laboratories; Professor, Pathology, University of Utah
Comprehensive Review: May 2008
Last Update: May 2008
