Metabolic syndrome

Metabolic syndrome: description

The metabolic syndrome summarizes various factors that often lead to cardiovascular disease. This includes:

• Overweight (obesity)
• a disturbed fat and cholesterol balance
• Hypertension (arterial hypertension) and
• a pathologically high blood sugar level due to insufficient insulin action

These four risk factors are favored by the Western lifestyle and play an important role in the development of vascular disease. In the Anglo-American language area, the combination of these four sub-disorders of the metabolic (affluence) syndrome is also called “deadly quartet”. In Germany, according to expert estimates, every fourth person suffers from a metabolic syndrome in the course of his life. It is believed that this will double the risk of dying from the effects of a heart attack or stroke. In addition, it is approximately five times more likely for a metabolic syndrome patient to develop diabetes mellitus (type 2 diabetes mellitus) if they are not actively addressing these risk factors.

Especially in the Western world, metabolic syndrome poses a significant problem because it combines great health risks and also causes high costs in health care systems. Statistically, the morbidity rate and mortality of the metabolic syndrome are much higher than those of HIV / AIDS.

Metabolic syndrome: symptoms

The symptoms of the metabolic syndrome often remain undetected for a long time as it does not itself cause pain or discomfort. The doctor usually diagnoses it accidentally during a check-up – or after a heart attack or stroke.

The obesity is clearly visible in the metabolic syndrome. Here are people who develop their love handles especially on the stomach (“apple type”, “beer belly”) more at risk than those who primarily on the hips and thighs increase (“pear type”).

Obesity is the most important part of the metabolic syndrome. Since there are many different forms of obesity, the International Diabetes Society (IDF) has determined that the metabolic syndrome is best assessed by the abdominal girth. Often, however, the BMI (Body Mass Index) is used. In the so-called tribal obesity (Android obesity), the vessels are the most damaged, so the abdominal girth is well suited to estimate the risk.

The limits of the waist circumference vary somewhat depending on ethnicity, but all of them are in the range of a maximum of 90 centimeters for men and 80 centimeters for women. From this value, the IDF definition refers to a skeletal obesity, the most important sign of a metabolic syndrome.

In order to speak of a metabolic syndrome, at least two more of the following factors must be met:

• disturbed fat metabolism, measured by elevated blood lipid levels. Even patients who are already being treated for increased blood lipids are considered at risk.
• low “good” (HDL) cholesterol
• increased arterial blood pressure. Even with already started treatments of high blood pressure, this factor does not fall out of the risk assessment of the metabolic syndrome.
• insulin resistance (Signs: increased fasting sugar in the blood) or a manifest Diabetes mellitus type 2 (Diabetes).

All of these signs are effects of a modern lifestyle. Say: lack of exercise and a wrong diet (too many high calorie foods).

Hypertension may in some cases cause headache, dizziness, nosebleeds, or a flushing sensation in the head, but may also occur without any discomfort.

Metabolic syndrome: causes and risk factors

It has not been proven beyond doubt what is the cause and what effect of the metabolic syndrome. However, researchers today assume that, for example, overweight with too much belly fat increases the risk of developing the metabolic syndrome. It is thus considered the strongest promoter of the metabolic syndrome.

All aspects of the metabolic syndrome are related. In many cases, there is a genetic predisposition to insulin resistance, which is promoted by an unhealthy lifestyle and thus can be (manifest). Since the insulin levels are then constantly high, there is an increased feeling of hunger and therefore too high a calorie intake. This changes the blood lipid and cholesterol metabolism. It deposits more fat and cholesterol in blood vessels.

At the same time, in the metabolic syndrome, the excretion of salts – especially saline (sodium chloride) – through the kidneys is disturbed. High levels of sodium in the body promote hypertension. This not only damages organs but also promotes small injuries to the inner wall of the vessel. It is believed that this favors the storage of fat and cholesterol in addition. Over the years, the cardiovascular system is increasingly damaged.

Discussion about hereditary factors

Every human carries information for all metabolic processes in his genes. Individually, this information varies slightly, so some people are at an increased risk of developing metabolic disorders. Also for the metabolic syndrome genetic factors are assumed. Nevertheless, the most important influenceable factor remains the lifestyle.

Besides these five risk factors, there are many other factors that can additionally increase the risk of cardiovascular disease, such as smoking.

Metabolic syndrome: examinations and diagnosis

Ideally, a metabolic syndrome occurs as early as possible during a check-up, not just after a heart attack, stroke, or other episode of arteriosclerosis.

Prehistory and readings

To diagnose a metabolic syndrome, the doctor asks current complaints and the so-called family history. So he wants to know if the family has diabetes, hypertension or lipid metabolism disorders. Heart attacks or near-related strokes may be an indication of a propensity to metabolic disorders that may eventually lead to a metabolic syndrome. Then follows a physical examination, the doctor or his assistants measure in particular the blood pressure and determine the waist circumference. A blood test is used to measure blood sugar and blood lipid levels. For this examination, the person concerned should be sober. Other factors, such as elevated levels of uric acid in the blood or increased urinary protein excretion, provide additional evidence of a metabolic syndrome. Liver levels in the blood show whether fatty liver has developed due to overweight or poorly controlled diabetes.

If no diabetes is known, but there is already evidence of a disturbed sugar metabolism, an oral glucose tolerance test (oGTT) is performed. The so-called fasting blood sugar is measured at the beginning of the examination. The patient then drinks a defined amount of a sugar solution. Two hours after this sugar intake, the blood sugar is redetermined. Diabetes mellitus is when the blood glucose level in the blood is more than 200 milligrams per deciliter (mg / dl) or 11.1 millimoles per liter (mmol / l). Often a beginning insulin resistance is the cause. In order not to falsify the result, the examination must take place before the first food intake in the morning.

Using electrocardiography (ECG) and ultrasound (sonography), the doctor can determine if there is damage to the heart or other organs. In severe narrowing of the blood vessels that supply the heart muscle, or after a heart attack, the ECG shows typical changes. In turn, ultrasound technology makes it easy to detect disturbances in cardiac muscle contractions.

Metabolic syndrome: treatment

In fact, if there is a metabolic syndrome, the primary treatment goal is to reduce the risk of secondary damage. The doctor will design an individual diet and treatment plan with the patient. Non-drug treatment approaches exist mainly in a change in lifestyle; with more exercise and a balanced low-fat diet – the so-called lifestyle change

This change in eating and eating habits captures all four aspects of the metabolic syndrome at the same time and achieves the best treatment outcomes. Many medical practices or health care providers provide training or patient information sheets to help them understand their condition and encourage them to cooperate. American and Finnish studies have shown that even small partial successes reduce or delay the occurrence of serious complications.

The most important goal is a moderate weight reduction of about 10-15 percent during the first year. This should be eaten especially carbohydrate and low fat. Also, the patient should reduce salt intake to counteract hypertension.

A regular dose of endurance training (at 60 percent of maximum performance) burns extra fat, while making the muscle cells more sensitive to insulin. New research results show that, in addition to endurance training, short maximum loads such as sprints can improve the effect even more. But even small changes in lifestyle can achieve something: the first step for many is to make the journey to work by bike or on foot.

In people with an already derailed metabolism or a very high cardiovascular risk, a concomitant drug therapy is required.

Blood lipids and cholesterol levels: Fibrates and statins are among the most important agents for the treatment of elevated blood lipids. The fabrics help to lower the “bad” LDL and increase the “good” HDL.

High blood pressure: so-called ACE inhibitors, and ATr blockers lower the wall tension of the arteries, so that the heart must overcome less resistance.

Insulin resistance and high blood sugar: drugs such as metformin or acarbose increase the secretion of insulin from the pancreas or improve the effect of the hormone on the cells. Both contribute to the fact that sugar from the blood can be channeled into the cells.

Metabolic syndrome: disease course and prognosis

The metabolic syndrome is so dangerous because it really only causes discomfort when it’s almost too late. Vascular calcification (arteriosclerosis), heart attacks, or strokes are events whose causes go unnoticed for years. The actual symptoms of an unhealthy lifestyle do not appear until many years after the triggering behavior. This often complicates the patient’s insight, because he does not feel ill and therefore often does not see himself changing his lifestyle. The best treatment results can be achieved with sports and a diet change. Many studies have shown that such measures can do more than use medications. One Metabolic syndrome therefore requires a very close and consistent collaboration between doctor and patient.