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]
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]
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.
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.
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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.