The Metabolic Syndrome or The Insulin Resistant Syndrome
The metabolic syndrome or the insulin resistant syndrome is a set of abnormalities which is associated with an elevated risk of cardiovascular disease and diabetes. The hallmark is excess adipose tissue deposition in the abdomen and this is detected by patients as an increased girth or waist circumference. The excess fat is found in the adipose tissue surrounding the organs in the abdomen. This fat has different properties and produces hormones associated with the syndrome and harmful to the lining of arteries, and is associated with an increased risk of inflammation to the arteries and clotting.
People are thought to have the metabolic syndrome if they have an increased girth, raised fasting insulin levels, high blood pressure, low HDL cholesterol (the good fraction), raised blood triglycerides and other abnormalities in part or in total.
The two major underlying risk factors for the metabolic syndrome are obesity and insulin resistance; exacerbating factors include physical inactivity and advancing age. The condition is progressive and beginning with borderline risk factors that eventually progress to categorical risk factors. In many patients, the metabolic syndrome culminates in type 2 diabetes which further increases the risk of cardiovascular disease.
Patients with the metabolic syndrome are almost 1.5 times more likely, respectively, to have major coronary events than those who did not have the metabolic syndrome and the risk increases with the number of abnormal constituents of this syndrome. The key abnormality associated with elevated risk in both studies were low levels of the protective high density lipoprotein. It is important to note that this increased risk in patients with metabolic syndrome occurred irrespective of the Framlingham risk score. This suggests that the metabolic syndrome is associated with future cardiovascular risk that is not entirely accounted for by traditional risk scoring paradigms.
Primary treatment of the metabolic syndrome is with lifestyle changes with weight loss, increased physical activity, and an anti-atherogenic diet. As the condition progresses, drug therapies directed towards the individual risk factors are required. So metformin is used increasingly if glucose tolerance deteriorates, statins, fibrates and omega 3 fatty acids for the lipid abnormalities and ACE inhibitors or angiotensin receptor or calcium channel blockers for the hypertension. Drugs that treat the underlying obesity – rimonabant or orlistat will also help.
Dr Ralph Abraham, May 2007
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