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Metabolic Syndrome

 Metabolic Syndrome

  •  Metabolic syndrome (MS) is a predictor and precursor to both diabetes and heart disease. It is mediated through insulin resistance and is usually accompanied by hyperinsulinemia and prothrombotic state.1, 2
  • Although there is controversy as  to whether cardiac risk in this syndrome exceeds that of the constituent risk factors, it serves a very useful purpose in clinical practice to identify high-risk individuals who must be targeted for aggressive lifestyle modification to prevent the development of diabetes and CAD in the next decade or two.3
  • MS confers a 2-fold risk of heart disease and stroke and 5-fold risk of diabetes. The risk is markedly increased when MS is accompanied by diabetes and doubly so in women. On a brighter side, the risk can be substantially reduced by aggressive lifestyle modification with a 60% reduction in the risk of developing diabetes.4
  • The confusion about the criteria for diagnosis seems to have resolved with all experts agreeing for uniform definition with the ethnic and gender specific cut points for abdominal obesity. 5 
  • It is worth noting that abdominal obesity is no longer an essential component and waist circumference is ethnic, gender and country specific, according to the 2009 expert consensus (Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and international association for the Study of Obesity). 5 
  • The five components metabolic syndrome are elevated blood sugar (>100 mg/dl), elevated blood pressure (>130/85mmHg), elevated triglycerides (>150 mg/dl), low HDL (<40 mg/dl for men and <50 mg/dl for women) and abdominal obesity, (no longer mandatory).6
  • The cutpoint for abdominal obesity for men is 102cm for Europids and 90cm for Asian Indians and all Asians. For women, the cutpoint for abdominal obesity is lower than in men ─ 88cm for Europids and 80cm for Asian Indian and all Asians.5, 6
  • For a given age, body mass index (BMI), and waist circumference or waist to hip ratio (WHR), Asian Indians have substantially higher rates of MS than Europids and other Asians.7-9
  • About one in three Asian Indian men and one in two Asian Indians has metabolic syndrome but the prevalence
  • The prevalence was underestimated by 50% when the now abandoned conventional NCEP or IDF criteria were used.5, 6, 10, 11

Sources

1. Stern MP. Diabetes and cardiovascular disease: The “common soil” hypothesis. Diabetes. 1995;44(4):369-374.

2. Wilson PW, Kannel WB, Silbershatz H, D’Agostino RB. Clustering of metabolic factors and coronary heart disease. Arch Intern Med. 1999;159(10):1104-1109.

3. Stern MP. The insulin resistance syndrome: The controversy is dead, long live the controversy! Diabetologia. 1994;37(9):956-958.

4. Mak KH, Ma S, Heng D, et al. Impact of sex, metabolic syndrome, and diabetes mellitus on cardiovascular events. Am J Cardiol. Jul 15 2007;100(2):227-233.

5. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and international association for the Study of Obesity. Circulation. Oct 20 2009;120(16):1640-1645.

6. Enas EA, Mohan V, Deepa M, Farooq S, Pazhoor S, Chennikkara H. The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. Journal of the cardiometabolic syndrome. Fall 2007;2(4):267-275.

7.Chandalia M, Abate N, Garg A, Stray-Gundersen J, Grundy SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. The Journal of clinical endocrinology and metabolism. 1999;84(7):2329-2335.

8. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. The Journal of clinical endocrinology and metabolism. 2001;86(11):5366-5371.

9. Dowse GK, Collins VR, Alberti KG, et al. Insulin and blood pressure levels are not independently related in Mauritians of Asian Indian, Creole or Chinese origin. The Mauritius Non- communicable Disease Study Group. J Hypertens. 1993;11(3):297-307.

10. Misra A , Chowbey P, Makkar B. Consensus statement for diagnosis of obesity, abdominal obesity, and metabolic syndrome, for Asian Indians and recomendations for physical activity, medical and surgical management. JAPI. 2009;57:163-170.

11. Enas  EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.

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