The Metabolic Syndrome

The metabolic syndrome is a recently defined constellation of known risk factors that has been associated with an increased risk of cardiovascular disease as well as the development of diabetes. While many of the cardiometabolic risk factors have the tendency to cluster in patients, the components of the metabolic

Table 7.5 NCEP ATP III criteria for the metabolic syndrome. From reference 33, with permission

Increased waist circumference (in men > 40 inches (> 102 cm)

and in women > 35 inches (> 88 cm)) Elevated triglycerides (a 150 mg/dL)

Low HDL cholesterol (men < 40 mg/dL and women < 50 mg/dL) High blood pressure (a 130/85 mmHg) Impaired fasting glucose (a 110 mg/dL)

syndrome occur together with great frequency. Several definitions of the metabolic syndrome exist including ones from the NCEP ATP III, the WHO, and the International Diabetes Federation. In general, most definitions endorse the following basic criteria: a measure of abdominal adiposity, hypertriglyceridemia, low HDL cholesterol levels, hypertension, and evidence of impaired glucose metabolism. The NCEP ATP III defines the metabolic syndrome as any three of the following: elevated triglycerides (a 150 mg/dL), low HDL cholesterol (men <40 mg/dL and women <50mg/dL), impaired fasting glucose (a 110mg/dL), high blood pressure (a 130/85 mmHg), and increased waist circumference (men > 40 inches, or > 102 cm, and women > 35 inches, or > 88 cm) (Table 7.5)33. The prevalence of the metabolic syndrome has steadily increased especially among middle-aged adults in the US, in part because of increasing clinician comfort with diagnosis, but also secondary to increasing prevalence of risk factors such as abdominal obesity73. The unadjusted prevalence of the metabolic syndrome was 23.1% among participants in NHANES III (1988-1994) compared with 26.7% in NHANES 1999-200073.

Numerous studies have established the metabolic syndrome as an important marker of cardiovascular risk. In a study of 4483 patients, the relationship between the metabolic syndrome as defined by the WHO criteria (which include microalbuminuria in place of impaired fasting glucose) and cardiovascular risk was examined74. Patients meeting criteria for the metabolic syndrome experienced a 3-fold increase in the risk of coronary artery disease and stroke74. Cardiovascular mortality was increased to 12% among patients with the metabolic syndrome compared with 2.2% in patients not meeting the WHO definition74. Of the various criteria constituting the WHO

Lakka 2002

Katzmarzyk 2004

Hunt 2004

Combined - Heterogeneity p = 0.033


Estimated relative risk

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