Metabolic syndrome

It is now abundantly clear that there is a metabolic condition characterized by a cluster of risk factors for accelerated macrovascular disease. It , in my opinion, represents about 75% of primary hypertension. This condition –first described and codified by G. Reaven in the 1980s and termed Syndrome X- has been considerably refined and is now known as the metabolic syndrome or the insulin resistance syndrome. The hallmarks of thic condition include obesity (especially central or troncular), glucose intolerance, hypertension, hypertriglyceridemia, low HDL cholesterol, hyperuricemia, and a variety of hemostasis abnormalities. These subjects are at high risk for diabetes and suffer from higher rates of coronary heart disease morbidity and mortality. Moreover some researchers identify metabolic syndrome with microvascular angina (angina + positive stress test for myocardial ischaemia + not narrowed coronaries). While the genetic basis of the metabolic syndrome is not yet established, it is clearly a polygenic, multiorgan system disorder. Given the high risk for progression to diabetes and atherosclerosis, it is of some urgency that these persons be identified early, have a comprehensive risk factors assessment, and be subjected to early interventions designed to reduce insulin resistance and ameliorate cardiovascular risk factors. Identification of high risk persons can be achieved by application of several screening criteria including waist circumference measurement, blood pressure and TG/HDL levels, blood glucose assessment, and family history. While not an algorithm as such, this approach is of practical utility, and when combined with the non-pharmacologic and pharmacologic approaches known to reduce insulin resistance, can serve as an effective intervention for arrest and/or reversal of metabolic syndrome. Particular attention should be paid to the roles of medical nutrition therapy, physical activity and insulin sensitizers


Clinical identification of the Metabolic syndrome.

Risk factor

Defining level in men

Defining level in women

Abdominal obesity

Waist circumference

> 102 cm (> 40 in)

> 88 cm (> 35 in)


≥ 150 mg/dL

≥ 150 mg/dL

HDL cholesterol

< 40 mg/dL

< 50 mg/dL

Blood pressure

≥ 130/ ≥ 85 mmHg

≥ 130/ ≥ 85 mmHg

Fasting glucose

≥ 110 mg/dL

≥ 110 mg/ dL

Same male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased. They have strong genetic contribution to insulin resistance and they should benefit from changes in life habits, similarly to men with categorical increases in waist circumference


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