Metabolic Syndrome: What Does It Look LIke?
Mrs Bates, aged 65 years, presents to your office for her annual physical examination. Overall, she is in good health and takes only atorvastatin 40 mg, prescribed for the past 8 years to treat hypercholesterolemia. On review of systems she reports to you that she has felt increasingly fatigued lately and finds that she is waking to urinate at least twice every night.
On physical examination, her body mass index is 31 kg/m2. A fasting lipid panel reveals the following values: total cholesterol, 182 mg/dL; LDL-C, 102 mg/dL; HDL-C, 48 mg/dL; VLDL of 32 mg/dL; and triglycerides, 158 mg/dL. Her TSH is within normal limits.
Answer: A. Yes
According to the International Diabetes Federation1 consensus worldwide definition of the metabolic syndrome (2006) is:
Central obesity (defined as increased waist circumference [or BMI >30 kg/m2]) PLUS any two of the following:
- Elevated triglycerides: >150 mg/dL
- Reduced HDL cholesterol: <50 mg/dL (1.29 mmol/L) in women
- Elevated blood pressure (BP): SBP >130 or BP >85 mm Hg, or treatment for hypertension
- Elevated fasting plasma glucose (FPG): >100 mg/dL, or previously diagnosed type 2 diabetes
Mrs Bates’ BMI is 31 kg/m2and her HDL-C is 48 mg/dL and her triglycerides are >150 mg/dL, therefore she meets the criteria for metabolic syndrome. Metabolic syndrome is an independent risk factor for adverse cardiovascular events and therefore a more aggressive primary prevention strategy should be pursued for Mrs. Bates. Strict dietary recommendations, intensive exercise, and medication to lower her triglycerides (such as fibrates) can be considered.
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1. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Update 2006. http://www.idf.org/webdata/docs/MetS_def_update2006.pdf. Accessed September 29, 2014.