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september 2012

Metabolic Syndrome: Awareness Is The Key

Dr P Seshagiri Rao & Dr P Ramya
Today, coronary artery disease has emerged as the most common cause of death worldwide. At the same time, it is also seen that comparatively, we Indians, as a group, are more prone to cardiovascular diseases.
Not only is the first myocardial infarction or heart attack seen to occur much early in Indians, it is also observed that the severity of the case and the associated number of complications are more pronounced in Indians.

One of the reasons behind it could be the clustering of a group of risk factors in our population: Indians are not only prone to diabetes and hypertension, but growing obesity and its associated dyslipidemia are causes of major concern too. This has led to the development of the concept of metabolic syndrome. Metabolic syndrome or Syndrome X is thus a constellation of metabolic abnormalities that increase the risk of diabetes and cardiovascular disease.

What Causes Metabolic Syndrome?
Obesity can be considered as the driving force behind metabolic syndrome. However, it is not the increase in body weight, but the distribution of fat around the waist (described as central adiposity) that is the most important factor. Obesity occurs when your total calorie intake exceeds the calorie needs of the body.
Increasing body fat and other unidentified mechanisms ultimately lead to defect in insulin action. This leads to insulin resistance, the most accepted and unifying hypothesis to describe the patho-physiology of metabolic syndrome. Inability to lower blood sugar levels and increased lipolysis in turn leads to diabetes and abnormal lipid levels. Insulin resistance is also linked to the development of hypertension and procoagulant states of metabolic syndrome.

Side Effects
Metabolic syndrome per se has no symptoms. But it carries with it the increased risk of much co-morbidities.
  • Risk of new-onset cardiovascular disease (CVD). Even in the absence of diabetes, the risk averages between 1.5 and threefold.
  • Increased risk for peripheral vascular disease.
  • The risk for type II diabetes is increased three to fivefold.
  • Associated also are non-alcoholic steato hepatitis (NASH), polycystic ovary syndrome, obstructive sleep apnoea and hyperuricemia.

Managing Metabolic Syndrome
Obesity being the prominent initiating factor, weight reduction is the primary approach to tackle metabolic syndrome. The second most important factor is how you treat diabetes, hypertension and dyslipidemia.

  • With weight reduction, the improvement in insulin sensitivity is often accompanied by favourable modifications in many components of metabolic syndrome.
  • A combination of calorie restriction, increased physical activity, and behaviour modification will go a long way.
  • Avoid high calorie foods like aerated beverages and deep fried foods.
  • Take to an exercise regime of a half hour’s duration everyday or at least five days a week.
  • Drug therapy may be needed if exercises are ineffective.
  • Bariatric surgery is not seen to be beneficial to heart. So, avoid short cuts; they do not work!!!
  • Diabetes management rests primarily on dietary restriction and lifestyle changes. Drugs or insulin therapy may also be needed.
  • In all patients with hypertension, a sodium-restricted diet, which is enriched with fruits and vegetables and low-fat dairy products, will be useful. Drugs may be needed to lower BP.
  • Though lipid levels can be controlled in a similar way, most of them would need statin therapy to effectively lower cholesterol levels.
Creating awareness about metabolic syndrome is as important as treating it. Simple changes that we can make in our lifestyle go a long way in preventing cardiovascular diseases. Taking some time out of our busy schedules to do some exercise and eating healthy food can help keep metabolic syndrome at bay.

Your Marker
Waist circumference (politely referred to as ‘apple obesity’ or rudely termed as ‘pot belly’) has been chosen as a simple and sensitive marker of metabolic syndrome. The maximum or the cut off value of waist circumference is cited as 102 cm in men and 88 cm in women. For South Asians or the population more prone to cardiovascular disease, this cut off limit is cited as 90 cm in men and 80 cm in women.
Dr P Seshagiri Rao Senior Consultant & Head of Department of Cardiology, Apollo Health City.