Makindo Medical Notes

⚠️ Metabolic Syndrome is defined by a cluster of risk factors including hypercholesterolaemia, hypertriglyceridaemia, impaired glucose tolerance/diabetes, hyperuricaemia, and hypertension. It markedly increases the risk of cardiovascular disease and stroke.

📖 About

• Also called Syndrome X or Insulin Resistance Syndrome.
• Core components: diabetes/insulin resistance, central obesity, hypertension, and dyslipidaemia.
• Prevalence: ~25–30% of adults in Western populations; rising globally due to obesity epidemic.
• Strongly linked to type 2 diabetes and premature coronary heart disease.

⚠️ Aetiology & Pathophysiology

• Underlying driver = insulin resistance, often secondary to visceral adiposity (central obesity).
• Additional mechanisms: atherogenic dyslipidaemia, endothelial dysfunction, low-grade chronic inflammation, genetic susceptibility, and sympathetic overactivity.
• Abnormal adipocytokines (TNF-α, IL-6, leptin, adiponectin) contribute to pro-inflammatory and pro-thrombotic state.
• Hypercoagulability (↑ fibrinogen, PAI-1) and chronic stress add to vascular risk.

📏 Diagnostic Criteria (IDF, 2005)

Diagnosis requires central obesity (waist circumference >94 cm for Europid men, >80 cm for Europid women) plus any 2 of:

• Raised triglycerides: >1.7 mmol/L (150 mg/dL) or on treatment.
• Reduced HDL: <1.03 mmol/L (40 mg/dL) in men, <1.29 mmol/L (50 mg/dL) in women, or on treatment.
• Raised blood pressure: ≥130/85 mmHg or treatment for hypertension.
• Raised fasting glucose: ≥5.6 mmol/L (100 mg/dL) or type 2 diabetes.

🧾 Risk Factors

• Obesity (especially central/visceral).
• Sedentary lifestyle and poor diet.
• Advancing age.
• Family history of diabetes and CVD.
• Ethnicity: South Asians and Afro-Caribbeans at higher risk.

🩺 Clinical Features

• Often asymptomatic until complications arise.
• Central obesity, elevated BP, hyperglycaemia, abnormal lipids.
• Can present with features of diabetes (polyuria, polydipsia, fatigue).
• Increased risk of fatty liver disease, gout (due to hyperuricaemia), and PCOS in women.

🔍 Differentials / Related Conditions

• Primary cardiovascular disease (e.g. MI, angina).
• Type 2 diabetes mellitus (progression risk is high).
• Polycystic ovarian syndrome (PCOS).
• Cushing’s syndrome and secondary causes of obesity/hypertension.

💊 Management

• Lifestyle: Cornerstone of therapy – diet (reduced refined carbs, lower saturated fat), weight loss, regular aerobic and resistance exercise, smoking cessation, reduced alcohol.
• Pharmacological:
  • Statins for dyslipidaemia.
  • Antihypertensives (ACE inhibitors/ARBs preferred in diabetics).
  • Metformin for insulin resistance/type 2 diabetes.
  • Allopurinol if significant hyperuricaemia/gout.
• Multifactorial approach: Simultaneous control of BP, glucose, and lipids gives the greatest CVD risk reduction.
• Monitoring: Regular review for CVD risk assessment, HbA1c, lipid profile, renal function.

📚 References

• NICE CKS – CVD Risk & Metabolic Syndrome
• International Diabetes Federation (IDF) Consensus Worldwide Definition of Metabolic Syndrome, 2005.

Clinical Exmaples

• ⚖️ Case 1 – Age 49: Overweight man (BMI 32 kg/m²) attended for an insurance medical. Bloods showed fasting glucose 6.4 mmol/L, triglycerides 2.5 mmol/L, HDL 0.9 mmol/L, and BP 148/92 mmHg. Waist circumference 108 cm. Diagnosis: Metabolic syndrome (abdominal obesity, dyslipidaemia, hypertension, impaired glucose tolerance). Management: Lifestyle modification with weight loss, aerobic exercise, and dietary counselling; started on statin and ACE inhibitor. Teaching point: Central obesity drives insulin resistance — early intervention prevents type 2 diabetes and cardiovascular disease.
• 🍔 Case 2 – Age 57: Woman with polycystic ovary syndrome (PCOS) presented with increasing waist size and fatigue. Fasting glucose 7.2 mmol/L, triglycerides 3.0 mmol/L, HDL 0.8 mmol/L. Diagnosis: Metabolic syndrome secondary to insulin resistance. Management: Metformin initiated, along with structured exercise and low-glycaemic index diet. Teaching point: In women, PCOS often coexists with metabolic syndrome — both improve with insulin-sensitising therapy and weight reduction.
• 🩺 Case 3 – Age 62: Retired lorry driver with long-standing hypertension and fatty liver found incidentally on ultrasound. BMI 34 kg/m², fasting glucose 6.9 mmol/L, triglycerides 2.1 mmol/L, HDL 0.7 mmol/L. Diagnosis: Metabolic syndrome with non-alcoholic fatty liver disease (NAFLD). Management: Weight reduction, alcohol minimisation, statin therapy, and annual screening for diabetes. Teaching point: NAFLD is now considered the hepatic manifestation of metabolic syndrome — improving insulin sensitivity can reverse early liver changes.