Saturday, February 20, 2010

What is "Metabolic Syndrome" and Why Should we Care?

Metabolic Syndrome is a collection of conditions that run together -- and increase a person's risk of having  heart disease, stroke, and /or diabetes.

I think this is critical to review from time to time, because it certainly is a "theme" in my medical practice and probably in MOST medical practices.

While definitions vary, I've paraphrased the definition given by the American Heart Association and the National Heart. Lung, and Blood Institute below:

They define "Metabolic Syndrome" as having three of the following criteria:
  • Elevated waist circumference (men greater than or equal to 40" and women greater than or equal to 35"). This is also known as "visceral obesity." Do you remember the image of being an "apple" vs a "pear" in body shape? Better to be a pear.
  • Elevated triglyceride levels (fasting level over 150 mg/dL)
  • Low HDL cholesterol: under 40 mg/dL in men and under 50 mg/dL in women. (By the way, I use this memory tool to help patients remember good cholesterol and bad cholesterol: "H is for Healthy; L is for lethal! We want more HDL and less LDL.")
  • Elevated blood pressure, i.e. greater than or equal to 130/85
  • Fasting blood sugar of greater than or equal to 100 mg/dL.
Particularly if an ESRD patient developed renal failure as a result of hypertension or diabetes, there's a good chance they have not just three of these criteria -- but ALL of them!

The bad news with Metabolic Syndrome is that it predisposes a person to diabetes, heart disease, stroke, and certainly CKD (Chronic Kidney Disease).

But the very excellent news is that Metabolic Syndrome can be prevented or even reversed!* How? By doing the following:
  • Becoming physically active: start with walking and move on from there.
  • Controlling body weight: even a 5% loss reduces risk.
  • Treating high blood pressure -- often the above measures, i.e. exercise and weight loss, will be enough to lower BP.
  • Getting diabetes diagnosed and treated early, to limit the damage it can do to both large and small blood vessels in the body.
  • Diagnosing and managing cholesterol properly.
These recommendations, while simple in essence, are tough for people to actually do. Just as with alcohol or overweight, sometimes we have to "hit bottom," have a personal scare, or see a friend suffer irreversable consequences that worry us to the point of changing our own behavior.

But it's interesting that physical activity and weight management can often be pre-emptive or curative. In other words, these two measures can in turn help manage blood pressure, diabetes, and abnormal cholesterol.

So, start with moving your body. Remember: the best exercise for a person is the one they will do! If that's walking, perfect. And like the Nike ad says, "Just do it!"

Metabolic Syndrome is one of the greatest challenges our country faces; we're seeing it in children and adolescents in alarming numbers. But we're not powerless here; we can help improve our own health and the health of our next generation.

And like Steve says, "I'd be happy if we could prevent Metabolic Syndrome in even one person."

And he should know...he's "on the hose" (i.e. dialysis) because of potentially preventable conditions.

Take care. Linda Gromko, MD
*Note: I'm not implying that ESRD is reversable here, unfortunately.

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