Metabolic Syndrome

Ketut Andriyasa
SMF Penyakit Dalam, RSUD Kabupaten Buleleng
Definition
"Metabolic Syndrome" (also referred to as
Syndrome X or Insulin Resistance
Syndrome) describes a cluster of CVD risk
factors and metabolic alterations associated
with excess fat weight.
 Characterized by five major
abnormalities

1. Obesity (central body and visceral)

2. Hypertension
3. Insulin resistance (hyperinsulinemia)
4. Glucose intolerance
5. Dyslipidaemia
Visceral obesity is associated with a
cluster of metabolic abnormalities

• Hypertriglyceridemia • Hyperinsulinemia
• Low HDL-C • Glucose intolerance
• Elevated • Insulin resistance
apolipoprotein B • Impaired fibrinolysis
• Small, dense LDL • Endothelial
particles dysfunction
• Inflammatory profile
These features can lead to type 2 diabetes,
hypertension
and cardiovascular disease
 Metabolic Syndrome:
NCEP ATP III Criteria
▪ Three or more of the following:
– Abdominal obesity
waist: male >102 cm, female >88 cm
( Asian : male > 90 cm,female > 80 cm)
– Triglycerides ≥150 mg/dL
– HDL cholesterol
Male <40 mg/dL, female <50 mg/dL
– SBP ≥130 mm Hg or DBP ≥ 85 mm Hg
– Fasting glucose ≥110 mg/dL (IFG)

NCEP=National Cholesterol Education Program.

ATP III=Third Report of NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
 METABOLIC SYNDROME

•Additional associated abnormalities may include:

– coagulation abnormalities,
– hyperurecemia,
– microalbuminuria,
– polycystic ovary syndrome,
– Non-alcoholic steattohepatitis (NASH)
 Prevalence Of The Metabolic
Syndrome By ATP III Criteria
(NHANES III Population)
• Overall 22% for age 20 years and
older

Age (y)

Adapted from Ford et al. JAMA. 2002;287:356-359.

 Significance of Metabolic
Syndrome

•Is characterized by metabolic and hemodynamic

abnormalities which each increase the risk of
cardiovascular disease.

When clustered together, the risk is greatly increased!

 Risk for CHD and Diabetes Based on
Number of Metabolic Syndrome Criteria
HR (95% CI) No. of
2 factors: 24.
5 40
0
1
2
0 2
3
1
5 ≥4

1
0 7.2
6
4.5
5 3.1 3.6 0
1.7 2.2 9 5 2.3
1 5 1 6
9
0
CHD Diabet
es
n 10. 32. 30. 20. 5.4 10. 32. 30. 21. 5.4
8% 2% 8% 8% % 8% 3% 5% 0% %

Sattar N et al. Circulation. 2003;108:414-419.

 Metabolic Syndrome as a Predictor of CHD
and Diabetes in WOSCOPS (5974 men)
CHD Death/Nonfatal MI Onset of New DM
No. of RR RR
14 factors: 12 24.40
4/5 3.65
3
12 3.19 10
2
1
10 8

% With Event
0 2.25
% With Event

1.79
6 6

1.00 7.26
4 4
4.50
2 2 2.36
1.00
0 0
0 1 2 3 4 5 6 0 1 2 3 4 5 6
Years Years

WOSCOPS=West of Scotland Coronary Prevention Study. 26.2% had metabolic syndrome; CHD event rate in DM=17.6%.
Sattar N et al. Circulation. 2003;108:414-419.
 Metabolic Syndrome: Total and CV
Mortality in Middle-Aged Men
in Kuopio Heart Study
All-Cause Mortality Cardiovascular Disease Mortality
20 20
Metabolic Syndrome Metabolic Syndrome
RR (85% CI) RR (85% CI)
Yes
Cumulative Hazard (%)

2.13 (1.64-3.61) 3.55 (1.96-6.43)

15 15

10 10
Yes
No
5 5

No
0 0
No. at Risk
Metabolic 0 2 4 6 8 10 12 0 2 4 6 8 10 12
Syndrome Follow-up (Years) Follow-up (Years)
Yes 866 852 834 292 Yes 866 852 834 292
No 288 279 234 100 No 288 279 234 100

Median follow-up (range) for survivors was 11.6 (9.1-19.7) years

Lakka HM et al. JAMA. 2002;288:2709-2716.
 Prevalence of Selected Risk Factors
Among Subjects With Metabolic Syndrome

Waist circumference Blood

Triglycerides pressure
HDL-cholestero
LDL-cholestero lFasting
10 l glucose
95.
0 1
84. 84. 86.
80. 82. 5
2 6 9
8 5 76.
73.
Syndrome of Subjects

7
0 2
62.
% of Metabolic

57. 6
6 6
0

4
0
22.
2 2 16.
7
0

0
Men Women
Treatment of Metabolic
Syndrome
■ Individuals with metabolic syndrome are
candidates for intensified therapeutic
lifestyle changes.
■ Treatment Goals include:
◆ LDL cholesterol reduction

◆ Weight reduction

◆ Treatment of elevated triglycerides and

low HDL
Treatment of risk factors should
be prioritized
■ The most common clinical feature of
metabolic abnormalities is excess body fat,
which is associated with many of the
additional defining characteristics.
◆ Reducing excess body fat should therefore be
the focus of treatment and prevention.
■ Physical activity and diet modifications are
indicated for the long-term treatment of
metabolic syndrome.
■ Pharmacotherapy of dyslipidemia is
indicated in high-risk groups.
ATP III Guidelines for Treatment
of Metabolic Syndrome
Treat LDL cholesterol first
Targeted Area Goal
CHD and CHD risk equivalent <100 mg/dL
(10-y risk for CHD >20%)
Multiple (2+) risk factors and <130 mg/dL
10-y risk < 20%
Institute weight control -10% from baseline
Institute physical activity 30 to 40 min/d for 3
to 5 d/wk
Monitor treatment of <130/85 mm Hg
hypertension
 20

Potential Benefits of Moderate

(5-10%) Weight Loss
Subcutaneous Adipose Tissue
5-10%
Visceral weight loss
Adipose ~30% Visceral adipose
Tissue tissue loss (diet, physical
activity, pharmacotherapy)

Blood Pressure
🡳 🡳
Deteriorated Lipid profile Improved

�� Insulin sensitivity ��
Impaired Improved
🡳 Insulinaemia, Glycaemia 🡳
�� Susceptibility to thrombosis ��

�� Inflammation markers ��
Abdominally Reduced Obesity
Obese (high waist (low waist
High Risk of coronary heart disease Low measurement)
measurement)
Després JP, BMJ
2001;322:716-20