Are you overweight…or do you have metabolic syndrome?

1.      Abdominal obesity (waist circumference 40 inches or more in men, 35 inches or more in women)

2.      Fasting triglyceride levels of 150 mg/dL or higher

3.      HDL cholesterol levels below 40 mg/dL in men, below 50 mg/dL in women

4.      Blood pressure of 130/85 mm Hg or higher

5.      Fasting blood sugar of 110 mg/dL or higher

The American Heart Association also lists elevated C-reactive protein (CRP) and elevated fibrinogen—proteins reflecting inflammation and increased coagulation of the blood, respectively—as possible criteria.

People who have as few as three of the five abnormalities qualify for the diagnosis. In all, 24% of American men and 23% of American women have Metabolic Syndrome. Incidence increases with age.

As described in a recent issue of Harvard Men's Health Watch, the metabolic syndrome is a cluster of cardiovascular risk factors. With the possible exception of triglycerides, each is important in its own right — but when they occur in a package, the total risk is greater than the sum of the parts. And that risk is substantial. An important 13-year study of 6,255 adults found that people with the problem were two times more likely to die from coronary artery disease than people without it. According to research published in 2005, hostility adds to the risk of the syndrome, quadrupling the chances of suffering a heart attack. Similarly, a study of over 1,000 men reported that the metabolic syndrome doubles the risk of stroke. And results suggest that the syndrome contributes to cognitive decline, kidney disease, and liver disease.

According to one theory, insulin is the driving force behind a vicious cycle of damage. The body seems to compensate for excessive insulin levels by producing more adrenaline, cortisol, and other stress hormones. These chemicals have two major effects. First, they boost the blood levels of free fatty acids and glucose; high glucose levels trigger more insulin release, perpetuating the cycle. Second, the stress hormones act with high sugar levels and insulin itself to raise blood pressure, damage the sensitive endothelial cells that line the arteries, and trigger the blood clots that can form on cholesterol-laden plaques to produce heart attacks and strokes.

Though obesity alone contributes to arthritis, diabetes, respiratory problems, and certain cancers, obesity as part of Metabolic Syndrome is especially unhealthy. The first step in addressing Metabolic Syndrome is to find out if you have it. A routine physical should include a blood pressure reading, fasting blood sugar and fasting cholesterol panel (which measures HDL and triglycerides as well as LDL and total cholesterol). If any of these are elevated plus your waist size is over 40 (men) or 35 (women) then your weight may be a particularly concerning health issue.

Next week I'll talk about treatment for Metabolic Syndrome.

Do you have any questions about what Metabolic Syndrome is, or why it's dangerous?

Dr. Suzanne Koven practices internal medicine with a special interest in weight issues at Massachusetts General Hospital in Boston, and teaches at Harvard Medical School.

Weigh Less

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