Makindo Medical Notes.com

Any combination of hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN

About

• Syndrome X or Metabolic Syndrome
• Group of risk factors for heart and stroke disease
• Diabetes, Obesity and hypertension and cholesterol
• Seen in 1/3rd of US population

Aetiology

• Underlying factor is Insulin resistance (due to obesity)
• Insulin resistance, visceral adiposity, atherogenic dyslipidaemia
• Endothelial dysfunction, genetic susceptibility, elevated blood pressure
• Hypercoagulable state, and chronic stress
• Increased production of abnormal adipocytokines
• Increased tumour necrosis factor, interleukin-1 (IL-1), IL-6, leptin, and adiponectin.

Definition: Central obesity (waist circumference > 94 cm for men and 80 cm for Europid women) plus any two of the following four factors

• Raised TG level > 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality
• reduced HDL cholesterol: < 40 mg/dL (1.0 mmol/L) in males and < 50 mg/dL (1.3 mmol/L) in females, or specific treatment for this lipid abnormality
• raised blood pressure: systolic BP = 130 or diastolic BP = 85 mmHg, or treatment of previously diagnosed hypertension
• raised fasting plasma glucose (FPG) = 100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes If above 5.6 mmol/L or 100 mg/dL, OGTT is strongly recommended but is not necessary to define the presence of the syndrome.

Aetiology

• Insulin resistance + older + sedentary
• Complex physiology poorly understood

Clinical

• Increased waistline, High BP, Diabetes, central obesity

Differentials

• Cardiovascular disease
• Increased Risk of Type 2 DM
• Prescribed reduction in dietary fat intake
• Smoking cessation
• Alternative

Management

• Restricting the overall dietary carbohydrate intake is more effective in reducing the most common symptoms of metabolic syndrome than the more commonly
• Lifestyle modification remains the initial intervention of choice for such a population. Modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioural strategies.
• Pharmacological treatment should be considered for those whose risk factors are not adequately reduced with lifestyle changes.
• This review provides a summary of the literature related to the syndrome's definition, epidemiology, underlying pathogenesis, and treatment approaches of each of the risk factors comprising metabolic syndrome.