Metabolic Syndrome

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Genetics 6 Clinical-manifestations 7 Laboratory 8 Complications 9 Management 10 More General Terms 11 Additional Terms 12 Internet Database 13 References

Introduction

• Characterizes individuals at risk for coronary artery disease.

Etiology

• linked to work stress [8]

Epidemiology

• overall prevalence 24% [4,5]
• prevalence of 44% age 60-70
• Mexican-Americans with highest prevalence of 32%
• male:female ratio 1 for whites, but < 1 for African-Americans & Mexican-Americans [4]

Pathology

• syndrome also occurs in primates

Genetics

• implicated genes: INPPL1, ENPP1

Clinical-manifestations

• abdominal obesity
• dyslipidemia
• elevated blood pressure
• insulin resistance
• waist circumference* > 102 cm (40 inches) in men or > 88 cm (35 inches) in women
• blood pressure* > 130/85 mm Hg or use of anti-hypertensive agent
• erectile dysfunction is common

Laboratory

• elevated 11-beta-hydroxysteroid dehydrogenase-1 in adipose tissue
• serum triglycerides* > 150 mg/dL
• HDL cholesterol* < 40 mg/dL (men), < 50 mg/dL (women)
• fasting serum glucose* > 100 mg/dL or use of hypoglycemic agent

Complications

• coronary artery disease

• risk of myocardial infarction similar to that conferred by diabetes mellitus type-2 alone [13]

• diabetes mellitus type-2
• stroke [9]

Management

• intensified life-style management

• diet
• exercise

• pharmaceutical agents

• consider statin for hyperlipidemia
• consider ACE inhibitor for hypertension
• consider metformin or acarbose for hyperglycemia
• aspirin 81 mg QD (high risk of cardiovascular disease)

• treatment of obstructive sleep apnea with CPAP may improve some components of metabolic syndrome, especially hypertension [14]
• gastric bypass
• sirtuins, because of their induction by life-prolonging calorie restriction, may serve as potential therapeutic targets for metabolic syndrome [10]

• * defining characteristics; 3 or 4 makes diagnosis

More General Terms

• chronic metabolic disease
• syndrome

Additional Terms

• 11-beta hydroxysteroid dehydrogenase-1 (corticosteroid 11-beta-dehydrogenase isozyme 1, 11-DH, 11-beta-HSD1, HSD11B1, HSD11, HSD11L)
• diabetes mellitus
• hypertension (HTN, high blood pressure, HBP)
• hypertriglyceridemia
• obesity

Internet Database

OMIM: 125853

References

1. Journal Watch 20(24):92, 2000
2. Journal Watch 21(11):86, 2001
3. Journal Watch 22(2):13, 2002
4. Journal Watch 22(4):28, 2002 Ford et al, JAMA 287:356, 2002
5. Prescriber's Letter 10(10):55 2003
6. Internal Medicine News 20(8)2005 cites R Shabsigh & data form the Massachussets Male Aging Study
7. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52. Epub 2005 Sep 12. No abstract available. <PubMed> PMID: [1] <Internet> [2]
8. Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ. 2006 Mar 4;332(7540):521-5. Epub 2006 Jan 20. PMID: [3]
9. Najarian RM et al, Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: The Framingham Offspring Study. Arch Intern Med 2006; 166:106 PMID: [4]
   - Kwon H-M et al, Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. Stroke 2006; 37:466 PMID: [5]
10. Guarente L. Sirtuins as potential targets for metabolic syndrome. Nature. 2006 Dec 14;444(7121):868-74. Review. PMID: [6]
11. Prescriber's Letter 15(6): 2008 Metabolic Syndrome in Children and Adolescents Detail-Document#: [7] (subscription needed) [8]
12. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
13. Mente A et al. Metabolic syndrome and risk of acute myocardial infarction: A case-control study of 26,903 subjects from 52 countries. J Am Coll Cardiol 2010 May 25; 55:2390. <PubMed> PMID: [9] <Internet> [10]
14. Sharma SK et al CPAP for the Metabolic Syndrome in Patients with Obstructive Sleep Apnea N Engl J Med 2011; 365:2277-2286 <PubMed> PMID: [11] <Internet> [12]
15. National Guideline Clearinghouse
    - Metabolic syndrome (Finnish Medical Society Duodecim) ngc-guideline: [13]
    - Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an Endocrine Society clinical practice guideline. ngc-guideline: [14]

metabolic syndrome X (obesity syndrome x, insulin-resistance syndrome, dysmetabolic syndrome)