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Table 1.  

Risk Factor Cutpoint
Abdominal obesity  
Men Waist circumference ≥ 40 inches
Women Waist circumference ≥ 35 inches
Elevated triglycerides ≥ 150 mg/dL
Low HDL cholesterol:  
Men < 40 mg /dL
Women < 50 mg/dL
Elevated blood pressure ≥ 130 / ≥ 85 mm Hg
Elevated fasting glucose ≥ 110 mg/dL

Table 1. ATP III Diagnostic Criteria for Metabolic Syndrome[37]

Table 1.  

Risk Factor Cutpoint
Abdominal obesity
Men Waist circumference ≥ 40 inches
Women Waist circumference ≥ 35 inches
Elevated triglycerides ≥ 150 mg/dL
Low HDL cholesterol:
Men < 40 mg /dL
Women < 50 mg/dL
Elevated blood pressure ≥ 130 / ≥ 85 mm Hg
Elevated fasting glucose ≥ 110 mg/dL

Table 1. ATP III Diagnostic Criteria for Metabolic Syndrome[37]

Table 2.  

Risk Factor Component Cutpoint for Abnormality
Overweight/obesity BMI ≥ 25 kg/m2
Elevated triglycerides ≥ 150 mg/dL
Low HDL-C  
Men < 40 mg/dL
Women < 50 mg/dL
Elevated blood pressure ≥ 130/85 mm Hg
2-hour postglucose challenge  
Other risk factors Family history of type 2 diabetes,
hypertension, or cardiovascular disease
Polycystic ovary syndrome
Sedentary lifestyle
Advancing age
Ethnic groups having high risk for
type 2 diabetes or cardiovascular disease

Table 2. AACE Diagnostic Criteria for the Insulin Resistance Syndrome*[37]

 

AACE = American Association of Clinical Endocrinologists; BMI = body mass index
*Diagnosis depends on clinical judgment, which is based on risk factors.

 

Table 3.  

Parameter Mean (SD)
Metabolic Syndrome
(n = 194)
No Metabolic Syndrome
(n = 382)
LDL-C, mg/dL    
Baseline 187 (20) 186 (18)
Week 12 99 (31) 96 (25)
% change -47 (15) -48 (12)
HDL-C, mg/dL    
Baseline 44 (9) 54 (13)
Week 12 49 (11) 58 (14)
% change +10 (13) +9 (12)
Triglycerides (mg/dL)    
Baseline 216 (60) 155 (57)
Week 12 167 (64) 122 (50)
% change -23 (20) -19 (24)
Non-HDL-C (mg/dL)    
Baseline 230 (23) 217 (21)
Week 12 132 (35) 120 (27)
% change -43 (14) -45 (12)
Non-HDL-C/HDL-C ratio    
Baseline 5.4 (1.2) 4.2 (1.0)
Week 12 2.8 (1.1) 2.2 (0.8)
Δ % -47 (15) -48 (13)
ApoB (mg/dL)    
Baseline 182 (22) 173 (20)
Week 12 115 (26) 106 (21)
% change -37 (14) -38 (12)
ApoA-I (mg/dL)    
Baseline 141 (23) 155 (25)
Week 12 150 (25) 164 (27)
% change +7 (13) +6 (12)
ApoB/ApoA-1 ratio    
Baseline 1.3 (0.3) 1.1 (0.2)
Week 12 0.8 (0.2) 0.7 (0.2)
% change -40 (15) -41 (13)

Table 3. Baseline and Week 12 Lipid Levels and Percent Change From Baseline in Patients With Hypercholesterolemia Treated With Rosuvastatin 10 mg

 

Reproduced with permission from Ballantyne et al.[57] Copyright 2004. Elsevier Science.

 

Metabolic Syndrome: A Growing Clinical Challenge

Authors: Scott M. Grundy, MD, PhDFaculty and Disclosures

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Introduction

Metabolic syndrome is a complex disorder and an emerging clinical challenge. It is considered a "multiplex" cardiovascular risk factor, in that each component of the cluster of abnormalities is a risk factor in its own right. Introduced as Syndrome X by Reaven in 1988[1] and also termed insulin resistance syndrome, metabolic syndrome is recognized clinically by the findings of abdominal obesity, elevated triglycerides, atherogenic dyslipidemia – ie, low levels of high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, high blood glucose and/or insulin resistance. Metabolic syndrome is also characterized by a prothromobotic state and a proinflammatory state.

Weight gain predisposes individuals to 2 pivotal components of metabolic syndrome: obesity and insulin resistance. Therefore, the high prevalence of metabolic syndrome is largely attributed to the alarmingly high and increasing prevalence of obesity across the world[2-8] and across demographic groups in the United States[9-15]— especially in adolescents, the elderly, white men, and black or Hispanic women.

The aims of this Expert Column are to consider epidemiologic data linking metabolic syndrome and/or its components to cardiovascular and type 2 diabetes risk; review the complex interplay of obesity, insulin resistance, atherogenic dyslipidemia, inflammation, and thrombosis in the pathogenesis of metabolic syndrome; survey consensus diagnostic criteria; and examine therapeutic options for the atherogenic dyslipidemia often associated with metabolic syndrome.