Metabolic

Syndrome
dr. Yunus Tanggo Sp.PD. PhD
Department of Internal Medicine,
Universitas Kristen Indonesia General
Hospital, Jakarta, Indonesia

Definition
The metabolic syndrome consists of a
constellation of metabolic abnormalities that
confer increased risk of cardiovascular disease
(CVD) and diabetes mellitus (DM).

Metabolic Syndrome (History)

HTN-Hyperglycemia-Gout - Kylin 1923

Insulin Insensitivity - Himsworth 1936
Diabetogenic Obesity - Vague
1947
Syndrome X Reaven
1988
WHO - Metabolic Syndrome
1998
NCEP - Metabolic Syndrome 2001
Dysmetabolic Syndrome (277.7)
2003

Other Names Used:

Syndrome X
Cardiometabolic Syndrome
Cardiovascular Dysmetabolic
Syndrome
Insulin-Resistance Syndrome
Metabolic Syndrome
Beer Belly Syndrome
Reavens Syndrome
etc.

Risk Factors

Overweight / obesity
Sedentary lifestyle
Aging
Diabetes mellitus
Coronary heart disease
Lypodystrophy

Pathophysiology of the Metabolic

Syndrome
Complex
Dyslipidemia

Endothelial
Dysfunction

Systemic
Inflammation

TG, LDL
HDL

Disordered
Fibrinolysis

Insulin
Resistanc
e

Hypertension
Type 2 Diabetes
Adapted from the ADA. Diabetes Care. 1998;21:310-314;
Pradhan AD et al. JAMA. 2001;286:327-334.

Atherosclerosis

Visceral
Obesity

Insulin resistance is a precursor to a variety of metabolic

abnormalities, including systemic inflammation, visceral
obesity, and type 2 diabetes.
Insulin resistance is also a risk factor for cardiovascular
abnormalities, including hypertension, dyslipidemia
(increased triglycerides and LDL and decreased HDL),
disordered fibrinolysis, and endothelial dysfunction.
All of these aberrations contribute to the atherosclerotic
process.

To measure waist circumference, 1) locate the upper hip bone and the top
of the right iliac crest, 2) place the measuring tape in a horizontal plane
around the abdomen at the iliac crest, 3) ensure that the tape is snug but
does not compress the skin, 4) the tape should be parallel to floor, and 5)
record the measurement at the end of a normal expiration.
Men are at increased relative risk if they have a waist circumference
greater than 40 inches (102 cm); women are at an increased relative risk
if they have a waist circumference greater than 35 inches (88 cm).
There are ethnic- and age-related differences in body fat distribution that
may affect the predictive validity of waist circumference as a surrogate
for abdominal fat.
Heterogeneity of composition of abdominal tissues, in particular adipose
tissue and skeletal muscle, and their location-specific and changing
relations with metabolic factors and CV risk factors in different ethnic
groups do not allow a simple definition of abdominal obesity that could
be applied uniformly. In particular, Asians appear to have higher
morbidity at lower cutoff points for waist circumference than do white
Caucasians.

Prevention and Treatment

of Metabolic Syndrome
Lifestyle management a program of weight loss and
exercise
Tobacco cessation
Limiting alcohol consumption
Changes in dietary habits, including eating a hearthealthy diet
Medication to help lower blood pressure, improve insulin
metabolism, improve cholesterol and increase weight
loss
Weight-loss surgery (bariatric surgery) to treat morbid
obesity in individuals for whom conservative measures
have failed.

ABCs of Metabolic Syndrome

Management
Intervention

Goals / Treatment

Antiplatelet agent

Treat all high-risk patients with

low-dose aspirin (or clopidogrel in
those with CVD if aspirin is
contraindicated) and consider lowdose aspirin in moderately highrisk patients.

BP Control

Aim for BP <130/85 mm Hg, or

<130/80 mm Hg for type 2 diabetes.
Consider ACE-I or ARBs and low
dose diuretics in combination rx.

ABCs of Metabolic Syndrome Management

Intervention Goals

Cholesterol
Management

LDL-C targets, ATP III guidelines

High Risk: CHD, CHD risk equivalents (incl.
>20% 10-year risk): <100 mg/dL (option <70 mg/dl
if CVD present)
Moderately High Risk (10-20% risk or
subclinical disease) 2 RF: <130 mg/dL, option <100
mg/dL
Moderate Risk (2+ RF, <10%) <130 mg/dL
-- Low Risk: 0-1 RF: <160 mg/dL
Non-HDL-C targets 30 mg/dL higher
HDL-C: >40 mg/dL (men)
>50 mg/dL (women)
TG: <150 mg/dL

Cigarette
Smoking

Long term smoking cessation

Thank you