The metabolic syndrome comprises a clustering of cardiovascular risk factors including abdominal obesity, insulin resistance, elevated triglycerides, low HDL-C and hypertension. The presence of metabolic syndrome increases cardiovascular risk by 1.6-2.6 fold. The greater risk occurs in patients with type 2 diabetes mellitus or elevated hs-CRP. Criteria for metabolic syndrome include ≥ 3 of the following parameters:
- Abdominal obesity (waist circumference in males >102 cm or 40 inches or in females >88 cm or 34.6 inches).
- Triglycerides ≥ 1.7 mmol/L
- HDL <1 mmol/L in males or < 1. 3 mmol/L in females
- BP ≥ 130/85
- FBG 6.2-7 mmol/L
The prevalence of metabolic syndrome in North America is approximately 25% and this reflects the rising prevalence of obesity and inactivity. Metabolic syndrome is associated with production of a variety inflammatory proteins including CRP. The presence of metabolic syndrome is a strong predictor of new onset of diabetes. In addition metabolic syndrome is associated with the presence of more atherogenic small dense LDL particles and elevated apoliprotein B levels which reflects the total number of atherogenic lipid particles.
The battle against metabolic syndrome is intricately linked to the battle against obesity and diabetes and includes:
- Weight reduction ≥ 5% body weight.
- Regular physical activity≥ 30 minutes 5 times/week
- Targeted therapy of dyslipidemia to lower LDL, raise HDL, lower triglycerides and optimize TC/HDL (<4/1) and LDL/HDL (<3/1) ratios
- Tight BP control optimally including use of an ACE inhibitor
- Tight BS control to achieve euglycemia ASAP with oral hypoglycemic therapy and insulin sensitizers as per CDA Guidelines