Consider metabolic syndrome a combination of different conditions

October 1, 2005

No wonder metabolic syndrome is called syndrome X. Instead of being recognized as a separate disease, it is considered a constellation of many conditions. "The biggest problem is a failure to address the underlying problem—insulin resistance," says Robert Epstein, MD, chief medical officer for Medco Health Solutions in Franklin Lakes, N.J. He calls metabolic syndrome one of the country's top five health problems.

Patients with metabolic syndrome have three or more of the following risk factors: excessive abdominal fat, low amounts of HDL, elevated triglyceride levels, high blood pressure and abnormal blood sugar. They are at three-and-a-half times greater risk of death from coronary heart disease and have increased risk for liver and kidney disease.

Although the prevalence of metabolic syndrome increases with age, it is present in as many as 5% of elementary school children, according to Family Practice News, which reported the results of a study presented in July at the annual meeting of the American College of Sports Medicine.

"Is there a problem called 'metabolic syndrome?'" asks Michael Fleming, MD, past president of the American Academy of Family Physicians and a practicing family physician in Shreveport, La. "It's academic. Metabolic syndrome is an amalgamation of diseases that begs for treatment by a primary care physician. It doesn't make sense to be treated by different physicians for each problem."

To David Katz, MD, director of the Prevention Research Center, Yale School of Medicine, metabolic syndrome is not viewed as a disease but rather, it is considered a precursor to diabetes. "By using metabolic syndrome as an indicator for diabetes, we can pull back patients from the brink by addressing obesity-the root cause of metabolic syndrome-and identifying treatable cardiovascular conditions," he says.

In August, the American Diabetes Assn. and the European Association for the Study of Diabetes issued a joint statement, saying that "metabolic syndrome" was poorly defined, inconsistently used and in need of further research. The president of the European diabetes association says that there is "no combination of risk factors that boost a person's cardiovascular risk beyond the sum of its parts, or constitutes a separate disease."

A paper published in the September issue of Diabetes Care and Diabetologia warned doctors that they should not diagnose people with the syndrome or treat it as a separate condition until the science behind it is clear.

In response, the American Heart Assn. (AHA) and the National Heart, Lung and Blood Institute (NHLBI) issued a statement, saying that metabolic syndrome consists of multiple, interrelated risk factors that increase the risk of cardiovascular disease by one-and-a-half to three times, raise the risk of diabetes 2 three to five times and affect more than 26 million adults in the United States.

Although the two organizations confirmed the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines, they did some tweaking: fasting glucose drops from equal to or greater than 110 milligrams per deciliter to 100; triglycerides greater than or equal to 400 milligrams per deciliter, if not fasting, and glucose greater than or equal to 140 milligrams per deciliter two hours after eating have been added; and less emphasis has been placed on waist circumference. A joint AHA/NHLBI panel states that an increased waist circumference serves as an effective diagnostic tool, but it is not necessary for the diagnosis of metabolic syndrome if other criteria are present. The panel also says that some persons who are not obese by traditional measures, may still be insulin resistant and have other metabolic risk factors.