Drug Study Institute
We Master the Details




SITE MENU

Welcome to DSI
For Patients
Concierge Care Club
Patient Resources
Enroll in a Study
Basic Research
Preventive Medicine
For Industry
For Doctors
About Us
Employment
Other Sites
Site Map
Patient Resources

DSI Newsletters, Issue 23:
The Metabolic Syndrome



 The Metabolic Syndrome (or Syndrome X as it's sometimes called) is emerging as an important preventable cause of cardiovascular morbidity and mortality as our weight climbs. Doctors are starting to hear more about it in their literature as patients hear more about it in the news media in relation to obesity becoming more prevalent.
 The Metabolic Syndrome is a footprint foretelling who is likely to get into trouble with heart disease and other vascular diseases. CHD risk is greater than that predicted by the LDL in the Framingham Risk Score. It is as bad a risk factor as smoking. It can be diagnosed by looking for the following:

Major Criteria:
  1. Insulin Resistance denoted by hyperinsulinemia relative to glucose levels.
  2. Impaired fasting glucose (intolerance) or type 2 diabetes mellitus
  3. Central Abdominal Obesity: Men: waist circumference more than 40" and Women: waist circumference more than 35"
  4. Atherogenic Dyslipidemia: High Total Cholesterol; Triglycerides more than 150. HDL less than 45 for Women, and less than 35 for Men.
  5. Hypertension: Elevated Blood Pressure.
  6. Hyperuricemia (high Uric Acid level in the blood).
  7. A special type of rash called Acanthosis Nigricans.
Minor Features:
  1. Hypercoagulability/Prothrombotic State: blood gets too thick (hyperviscosity) and clots inside the artery causing heart attack (MI) or stroke (CVA). Increased fibrinogen and PAI-1 (plasminogen activator inhibitor-1) levels.
  2. Proinflammatory State: increased CRP.
  3. Polycystic Ovarian Disease (PCOD).
  4. Vascular Endothelial Dysfunction: the inside of the artery doesn’t work correctly.
  5. Microalbuminuria: the kidneys fail and allow protein to go in urine inappropriately.
  6. Coronary Heart Disease: blockages in the arteries located on the surface of the heart causing angina pectoris and heat attack. requiring angioplasty or bypass surgery.
  7. Small, dense LDL particle size.
  8. Increased Apolipoprotein B.
To make the diagnosis of the metabolic syndrome, you need at least three of the following:
  1. Abdominal Obesity: Men waist more than 40" Women waist more than 35".
  2. Triglycerides more than 150.
  3. Low HDL: Men less than 40 women less than 50.
  4. HTN: BP more than 130/85.
  5. Glucose Intolerance: fasting sugar more than 109.
How to modify/correct the risk of having the metabolic syndrome:
  1. Lose weight.
  2. Increase physical activity.
  3. Control blood pressure.
  4. Control blood glucose level.
  5. Control Cholesterol: maximize the good HDL; minimize the bad LDL, TG and small dense LDL.
  6. TLC Diet (Therapeutic Lifestyle Change):
    • Polyunsaturated fat: up to 10% of total calories.
    • Monounsaturated fat: up to 20% of total calories.
    • Total fat: 30% total calories.
    • Carbohydrate: 55% total calories.
    • Dietary Fiber: 25 gm’s daily.
    • Protein: about 15% of total calories.
  7. Metamucil with meals (soluble viscous fiber) 25 gm daily.
  8. Benecol: Plant stanols/sterols 2 gm daily.
  9. Aspirin to treat the Prothrombotic state.
  10. Omega-3 fatty acids: to treat the hypertriglyceridemia.
 Click here to learn more about Syndrome X.