Metabolic Syndrome Risk Factors

Stress

Prolonged stress can be an underlying cause of Metabolic syndrome by upsetting the hormonal balance of the Hypothalamic-pituitary-adrenal axis (HPA-axis). A dysfunctional HPA-axis causes high cortisol levels to circulate which results in raising glucose and insulin levels. High cortisol levels (low levels may register due to HPA-axis 'burn out') can also cause loss of muscle bulk, accumulation of visceral fat and raised levels of clotting factor. All of these factors contribute to the damage of the endothelial lining of the artery wall which results in endothelial dysfunction or coronary artery disease which is then accelerated by further high levels of blood sugar, insulin, cortisol, and adrenaline. Raised levels of blood-clotting factors are also "directly and consistently associated with an increased risk of heart disease."

Overweight and Obesity

Central adiposity is a key feature of the syndrome, reflecting the fact that the syndrome's prevalence is driven by the strong relationship between waist circumference and increasing adiposity. However, despite the importance of obesity, patients that are of normal weight may also be insulin-resistant and have the syndrome.

Sedentary lifestyle

Physical inactivity is a predictor of CVD events and related mortality. Many components of the metabolic syndrome are associated with a sedentary lifestyle, including increased adipose tissue (predominantly central); reduced HDL cholesterol; and a trend toward increased triglycerides, blood pressure, and glucose in the genetically susceptible. Compared with individuals who watched television or videos or used their computer for more less one hour daily, those that carried out these behaviors for greater than four hours daily have a twofold increased risk of the metabolic syndrome., and is considered to be a risk factor for developing metabolic syndrome.

Coronary Heart Disease

The approximate prevalence of the metabolic syndrome in patients with coronary heart disease (CHD) is 50%, with a prevalence of 37% in patients with premature coronary artery disease ( age 45), particularly in women. With appropriate cardiac rehabilitation and changes in lifestyle (e.g., nutrition, physical activity, weight reduction, and, in some cases, Drugs), the prevalence of the syndrome can be reduced. and the revised National Cholesterol Education Program, respectively. The revised NCEP and IDF definitions of metabolic syndrome are very similar and it can be expected that they will identify many of the same individuals as having metabolic syndrome. The two differences are that IDF state if BMI>30 kg/m² central obesity can be assumed and waist circumference does not need to be measured. However, this potentially excludes any subject without increased waist circumference if BMI<30, whereas, in the NCEP definition, metabolic syndrome can be diagnosed based on other criteria and the IDF uses geography-specific cut points for waist circumference, while NCEP uses only one set of cut points for waist circumference regardless of geography. These two definitions are much closer to each other than the original NCEP and WHO definitions.

IDF

International Diabetes Federation

central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 36 inches(female)
dyslipidaemia: TG ≥ 1.695 mmol/L (150 mg/dl)
dyslipidaemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female)
blood pressure ≥ 130/85 mmHg
fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dl)

American Heart Association/Updated NCEP

There is confusion as to whether AHA/NHLBI intended to create another set of guidelines or simply update the NCEP ATP III definition. According to Scott Grundy, University of Texas Southwestern Medical School, Dallas, Texas, the intent was just to update the NCEP ATP III definition and not create a new definition.:

Elevated waist circumference:
- Men — Equal to or greater than 40 inches (102 cm)
- Women — Equal to or greater than 35 inches (88 cm)
- Elevated triglycerides: Equal to or greater than 150 mg/dL
- Reduced HDL (“good”) cholesterol:
  - Men — Less than 40 mg/dL
  - Women — Less than 50 mg/dL
  - Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension
  - Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia

Other

High-sensitivity C-reactive protein (hs-CRP) has been developed and used as a marker to predict coronary vascular diseases in metabolic syndrome, and it was recently used predictor for non-alcoholic fatty liver disease in correlation with serum markers that indicated lipid and glucose metabolism.