METABOLIC SYNDROME

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METABOLIC SYNDROME

• Dr. Raluca Procee
• GP-Registrar

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Definition

• Metabolic syndrome, described as the epidemic
  afflicting Europe has 6 central components
• - Abdominal obesity increased waist
  circumference
• - Dyslipidaemia raised triglycerides
  and low HDL cholesterol
• - Raised blood pressure
• - Insulin resistance with impaired glucose
  tolerance
• - Low grade inflammation, with elevated
  levels of CRP
• - Prothrombotic state with increased plasma
  levels of plasminogen
• activator inhibitor and fibrinogen.
• The WHO definition is not suitable for use in
  primary care.(Diabetic Medicine 1998).
• The Adult Treatment Panel III of the US National
  Cholesterol Program(NCEP).
• International Diabetes Federation - newer
  definition(Lancet 2005)

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ATP III definition of metabolic syndrome (JAMA
2001) If a subject has 3 or more of the
following Central obesity(waist
circumference) -Men gt 102cm
- Women gt 88cm Triglycerides
gt1.69mmol/l HDL cholesterol - Men
lt1.03mmol/L - Women lt
1.29mmol/L Blood pressure gt130/85mmHg Fasting
plasma gt6.1mmol/l glucose
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Epidemiology

• Metabolic syndrome has a rising prevalence within
  the adult population in developed countries,
  currently around 30.
• By the year 2010, the metabolic syndrome is
  expected to affect 50-75million people in the US
  alone.
• Factors responsible for the rising prevalence are
  the increasing incidence of obesity, due to
  excessive dietary calorie intake and reduced
  physical exercise when analyzed at a population
  level.
• In the UK, metabolic syndrome is a particular
  hazard in the Asian community, because of very
  high incidence of CHD and type 2 diabetes.(Br Med
  J 2005).

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Clinical evidence

• Major studies such as UK Prospective Diabetes
  Study(UKPDS), show that glycaemia is only
  modestly linked to cardiovascular disease in type
  2 diabetes. It is believed therefore that
  hyperglycaemia does not cause vascular disease,
  but the insulin resistance is responsible for
  both vascular disease and type 2 diabetes.(Lancet
  and BMJ 1998).
• A recent study published in BMJ 2006, shows that
  independently of other risk factors , metabolic
  syndrome is associated with a 40 to 60 increase
  in total and cardiovascular mortality.
• Apart from the insulin resistance, weight gain
  and physical inactivity, as the major causes of
  the metabolic syndrome a recent study(BMJ 2006)
  reveals a link between metabolic syndrome and
  work stress.

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MANAGEMENT (1) 1.Lifestyle and diet
Weight loss is the mainstay as this independently
reduces insulin resistance - to reduce the
caloric intake, to increase physical
exercise. Omega-3 fatty acids - beneficial
effect in lipid metabolism, coagulation,
inflammation and vascular tone.(oily fish/dietary
supplements Mediterranean diet has been able to
reduce insulin resistance and inflammatory
markers. Smokers should be encouraged to quit
(NRT, Bupropion)- atherogenesis in high-risk
patients.
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MANAGEMENT (2)

• 2. Weight
• There are 2 products licensed for weight loss
• Orlistat works by reducing the fat absorption by
  the gut. Sibutramine (amphetamine-like), is an
  appetite suppressant.
• Waist circumference compared with the BMI,
  gives a much more accurate indication of
  cardiometabolic risk, is easily performed by the
  patient, needs no calculation and is a tangible
  figure.
• 3.Blood pressure
• High blood pressure should be treated according
  to the guidelines issued by the British
  Hypertension Society.
• ASCOT trial has shown that ACE inhibitors and
  ARBs may reduce the development of diabetes in
  vulnerable patients.

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MANAGEMENT (3)

• 4. Insulin resistance
• - Metformin and the glitazone group of drugs,
  reduce insulin resistance, but their use is not
  yet recommended in the absence of frank diabetes.
  
• 5. Dyslipidaemia
• - if at high risk, gt20 in 10years, the
  patients should be offered a statin. The aim is
  for total cholesterol lt4mmol/l,
• HDLgt1 mmol/l, LDLlt2mmol/l , plus TG lt1.7mmol/l.
• 6. Antiplatelets agents
• - British Hypertension Society recommends
  Aspirin if the 10year risk of CHD exceeds 20.

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Conclusions

• Metabolic syndrome is a combination of risk
  factors for the development of type 2 diabetes
  and CHD.
• The key physical symptom is abdominal obesity
  resulting in insulin resistance.
• Look at the patients with hypertension and
  abdominal obesity - do they have metabolic
  syndrome?

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ANY QUESTIONS?
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