World Hypertension Day: Metabolic Syndrome increases the risk of developing more serious chronic conditions such as cardiovascular diseases, hypertension or diabetes
World Hypertension Day: Why heart should be healthy
Metabolic Syndrome or Syndrome X or Dysmetabolic Syndrome is a collection of factors or conditions that increase the risk of developing heart disease, stroke and diabetes. The risk factors for Metabolic Syndrome are – high blood sugar, high blood pressure, high triglycerides levels, low HDL cholesterol levels and increased waist circumference.
Metabolic Syndrome is a serious health condition as the incidence of the disease is increasing worldwide in both men and women. Overweight, obesity, insulin resistance, physical inactivity, genetic factors, age, ethnicity, stress, smoking and alcohol are predisposing factors for metabolic syndrome. Three or more of the following criteria are required for the diagnosis of Metabolic Syndrome-
1) waist circumference: 40 inches or more for men and 35 inches or more for women
2) blood pressure: 130/85 mm Hg or higher or on blood pressure-lowering medications
3) triglyceride level above 150 mg/dl
4) fasting blood glucose level greater than 100 mg/dl or are taking glucose-lowering medications
5) high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women)
Metabolic Syndrome increases the risk of developing more serious chronic conditions such as cardiovascular diseases, hypertension or diabetes. Other conditions that may develop as a result of Metabolic Syndrome include: Polycystic ovarian syndrome (PCOS), fatty liver, gallstones, obstructive sleep apnea and cancers. Each component of the Metabolic Syndrome is an independent risk factor for cardiovascular disease and the combination of these risk factors increases the rate and severity of the cardiovascular disease.
The entire spectrum of cardiovascular conditions including microvascular dysfunction, coronary atherosclerosis and calcification, cardiac dysfunction, myocardial infarction and heart failure, can be a consequence of Metabolic Syndrome. Hemodynamic and pathopysiological changes associated with Metabolic Syndrome contribute to cardiac dysfunction which includes an increase in heart rate, salt retention, increase in circulating blood volume and cardiac output and raised blood pressure. High cholesterol, high blood sugar levels and high blood pressure facilitate the formation of plaques in the arteries.
These plaques narrow and harden your arteries, leading to cardiovascular events like myocardial infarction or stroke. Obesity associated changes include a greater increase in cardiac mass than cardiac volume, leading to enlarged cardiac size with compromised cardiac function. Insulin resistance is the core feature of Metabolic Syndrome contributing to elevated sugar levels, fatty acid levels and insulin levels. There are complex molecular mechanisms that contribute to cardiac and pancreatic cell dysfunction.
The procressive microvascular and atherosclerotic changes cause decrease in coronary contractility and blood flow leading to adverse cardiac events. Microvascular dysfunction is found in other organs like the kidney, brain and skeletal muscle too. The main pathophysiologic changes include alterations in cardiac metabolism, microvascular dysfunction, impaired oxygen supply and demand balance, cardiac contractility dysfunction and increase in cardiac size.
Treatment involves lifestyle changes like weight loss, dietary modifications, exercise, and quitting smoking and alcohol. Weight loss improves triglycerides and cholesterol, lowers blood pressure,increses insulin sensitivity, reduces waist circumference and reduces the risk for type 2 diabetes. Diet should include plenty of vegetables, fruits, lean protein and whole grains and limit saturated fat and salt. Exercise for at least 30 minutes a day for five days a week. A healthy lifestyle should be a lifelong commitment.
The complicated, inter-dependent, multi-factorial nature of Metabolic Syndrome makes it difficult to completely eliminate the complications of the disease. Early interventions with weight loss, diet and exercise can reverse the magnitude of cardiovascular risk and its implications and prevent its progression. It is the need of the hour to understand, identify and treat Metabolic Syndrome and its associated cardiovascular disease as it is a huge and increasing public health problem.
The author is a Consultant, Endocrinology at Global Hospital, Parel, Mumbai. Views are personal.
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