Revisional Surgery

Metabolic Syndrome (Syndrome X; Insulin Resistance Syndrome; Dysmetabolic Syndrome)
Definition: Metabolic syndrome is a group of risk factors for cardiovascular diseases. Metabolic syndrome puts a person at risk for:

• Diabetes
• Coronary artery disease
• Heart attack
• Stroke
• Peripheral vascular disease

Metabolic syndrome is characterized by:

• Central obesity: high amount of fat around the waist
• Low levels of high density lipoprotein (HDL) cholesterol
• High levels of triglycerides: type of fat measured in the blood
• Elevated blood pressure
• Elevated fasting blood sugar
• Coronary heart disease

Causes

The exact cause of metabolic syndrome is not known. It is believed to be due to a combination of factors, such as:

• Genetic factors
• Central obesity
• Lack of physical activity
• Poor diet

Risk Factors

Factors that increase your risk of metabolic syndrome include:

• Ethnicity: Mexican American women, Caucasians, and African Americans.
• Obesity
• Having disorders or conditions associated with metabolic disorder such as:
  • Diabetes
  • High blood pressure
  • Cholesterol problems
  • Coronary artery disease
  • Polycystic ovary syndrome
• Genes: Having a family history of the disorders listed above
• Physical inactivity
• Poor diet
• Unhealthy habits, such as smoking
• Certain medication, such as atypical antipsychotics

Symptoms

Except for obesity, there are no obvious symptoms.

Diagnosis

You may be diagnosed with metabolic syndrome if you have at least three of the following:

• Waist measurement: greater than 40 inches in Caucasian men (35 inches in Asian men) or 35 inches in Caucasian women (30 inches in Asian women)
• Fasting glucose level: greater than or equal to 100 mg/dL* (5.55 mmol/L*)
• Triglyceride level: greater than or equal to 150 mg/dL (1.7 mmol/L)
• HDL cholesterol: less than 40 mg/dL (1.0 mmol/L) in men and less than 50 mg/dL (1.3 mmol/L) in women
• Blood pressure: greater than or equal to 130/85 millimeters of mercury (mm Hg)

*mg/dL = milligrams per deciliter blood, mmol/L = millimoles per liter blood

Treatment

The treatment of metabolic syndrome involves:

• Treatment of underlying causes
• Treatment of specific metabolic abnormality

Gastric bypass or other weight loss surgery may be helpful to treat metabolic syndrome. Talk to your doctor to learn if this is an option for you.

Treatment of underlying causes

• Reducing excess weight by at least 10% in the next 6-12 months
• Increasing physical activity to 30-60 minutes of moderate aerobic exercise four or more days per week as approved by your doctor
• Lowering blood pressure to below 130/85 mmHg with diet, exercise, and possibly medication
• Improving triglyceride and HDL cholesterol levels through diet, exercise, and possibly medication

Treatment of specific metabolic abnormalities

• High blood pressure: treated with anti-hypertensive medication and lifestyle changes
• Insulin resistance: treated with diabetes medications and lifestyle changes
• High cholesterol: treated with cholesterol-lowering medications called statins and lifestyle changes
• Clotting tendency: treated with low-dose aspirin, especially in those with moderate to high cardiovascular risk

Prevention

To reduce your chances of metabolic syndrome, take these steps:

• If you smoke, talk to your doctor about how to quit.
• Achieve and maintain a healthy weight by eating fruits, vegetables, and whole grains.
• Work up to 30 minutes of moderate aerobic exercise at least four days per week.