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Metabolic syndrome. Symptoms of metabolic syndrome You may not have any symptoms of metabolic syndrome. You usually find out you have it after a blood test or check-up. Check if you're at risk of metabolic syndrome Metabolic syndrome is very common.

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Current Hypertension Reviews. Close Print this page. Export Options ×. Export File: RIS for EndNote, Reference Manager, ProCite. Content: Citation Only. Citation and Abstract. About this article ×. Metabolic syndrome is a group of five conditions that can lead to heart disease , diabetes , stroke and other health problems.

Metabolic syndrome is diagnosed when someone has three or more of these risk factors:. Although each of these is a risk factor for cardiovascular disease, when a person has three or more and is diagnosed with metabolic syndrome, the chance of developing a serious cardiovascular condition increases.

For example, high blood pressure is an important risk factor for cardiovascular disease, but when combined with high fasting blood sugar levels and abdominal obesity large waistline , the chance for developing cardiovascular disease is intensified.

Metabolic syndrome is a serious health condition that puts people at higher risk of heart disease, diabetes, stroke and diseases related to fatty buildups in artery walls atherosclerosis.

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Download references. Department of Internal Medicine, The Jikei University School of Medicine, Chiba, Japan. Department of Laboratory Medicine, The Jikei University School of Medicine, Chiba, Japan. You can also search for this author in PubMed Google Scholar.

Correspondence to Hidekatsu Yanai. This article is published under license to BioMed Central Ltd. Reprints and permissions. Yanai, H. et al. The underlying mechanisms for development of hypertension in the metabolic syndrome.

Nutr J 7 , 10 Download citation. Received : 16 December Accepted : 17 April Published : 17 April Correspondence Details: Alejandro de la Sierra, Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Dr Robert, 5, Terrassa, Spain.

E: adelasierra mutuaterrassa. es; asierra ub. The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence.

The CC BY-NC option was not available for Radcliffe journals before 1 January Permission is required for reuse of this content. Cardiometabolic risk represents a situation where the possibilities of developing atherosclerotic cardiovascular disease and diabetes are significantly enhanced as a consequence of the presence of insulin resistance and atherogenic dyslipidaemia.

Dyslipidaemia is characterised by the presence of low high-density lipoprotein HDL cholesterol and high triglyceride levels. Cardiometabolic risk is particularly prevalent in patients diagnosed as having metabolic syndrome MS.

The prevalence of MS in the hypertensive population is very high. MS, and consequently increased cardiometabolic risk, are therefore very prevalent in the hypertensive population and need to be incorporated into a correct risk stratification to be carried out on every hypertensive patient.

In fact, the European Society of Hypertension—European Society of Cardiology 7 guidelines consider the concomitant finding of arterial hypertension and MS as a situation of high added cardiovascular risk.

The reason for this is based on two factors. First, MS and the accompanying cardiometabolic risk result in a significant increase in cardiovascular morbidity and mortality in several population-based studies, 8 as well as in hypertensive patients.

The development of new-onset diabetes and its relevance in people with hypertension has been widely considered. A network meta-analysis 14 has shown that the best protection is obtained when angiotensin-receptor blockers ARBs and ACE inhibitors are used, while diuretics and beta-blockers occupy the last position when used in combination.

However, some authors have denied that the development of new-onset diabetes worsens the short-term prognosis of hypertensive patients, according to data from studies such as Systolic Hypertension in the Elderly SHEP 15 and Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial ALLHAT.

In fact, it was shown with 2. The aim of intervention in patients with MS and high cardiometabolic risk is to achieve an optimal reduction of such risk. Lifestyle modifications counteract the effect of underlying risk factors obesity, physical inactivity and atherogenic diet.

Moreover, patients with hypertension also require tight BP control, a choice of antihypertensive treatment that does not produce other metabolic disturbances and, quite often, parallel drug treatment for associated metabolic risk factors dyslipidaemia, insulin resistance, pro-thrombotic and pro-inflammatory states.

Lifestyle interventions are obviously the first step in achieving cardiometabolic risk reduction. The key lifestyle interventions are the promotion of exercise and energy expenditure and reduction in weight with a calorie-restricted diet.

Whereas extreme calorie-restricted or element-dissociated diets have no long-term advantages, more intensive exercise programmes have additional cardiovascular benefits and help to maintain weight loss. Lifestyle interventions clearly have beneficial effects on BP and lipid profile and reduce the incidence of new-onset diabetes.

Other lifestyle changes also have a beneficial effect on specific cardiovascular risk factors and must be encouraged in specific patients. Lowering salt intake and alcohol consumption has moderate BP-lowering effects, which are enhanced in conjunction with weight loss and increased exercise.

For this reason, pharmacological treatment of BP, dyslipidaemia, insulin resistance and obesity will be required in order for most patients to reduce their cardiometabolic risk. As mentioned above, the European Society of Hypertension— European Society of Cardiology guidelines 7 emphasise the importance of MS as an indicator of high added cardiovascular risk in patients with hypertension.

The guidelines indicate early antihypertensive treatment if lifestyle measures are not enough to reach BP targets. No comparative studies are available of the different antihypertensive drug classes in people with hypertension and MS.

Considering the increased risk of developing new-onset diabetes in these patients as a component of cardiometabolic risk, the choice of antihypertensive treatment must take this additional risk into account. Some international guidelines recommend diuretics as the first-step therapy for hypertensive patients, without a compelling indication for other antihypertensive drug classes.

These differences are probably even more pronounced in the specific subset of patients with MS. Thus, it seems reasonable that primary antihypertensive treatment in patients with hypertension, MS and high cardiometabolic risk should focus on inhibition of the renin—angiotensin system with either ACE inhibitiors or ARBs.

Additional evidence can be derived from comparative studies of antihypertensive drugs that have included an important proportion of diabetic subjects, most of them also suffering from MS.

In this regard, the Appropriate Blood pressure Control in Diabetes ABCD study 24 compared antihypertensive treatment based on the ACE inhibitor enalapril or calcium-channel blocker nisoldipine in the subset of hypertensive patients with diabetes.

The study was prematurely halted due to the differences in the number of myocardial infarctions that favoured enalapril in comparison with nisoldipine. Patients with hypertension and MS, especially those with type 2 diabetes, are often resistant to the effects of antihypertensive drugs and may require drug combinations to achieve BP control.

ASCOT 27 compared antihypertensive treatment based on the calciumchannel blocker amlodipine with the addition of the ACE inhibitor perindopril in most patients against the beta-blocker atenolol with the addition of a thiazide diuretic, also in the vast majority of patients.

The study was also prematurely ended due to a consistent benefit of the former therapeutic option. More than 5, patients with diabetes were included in ASCOT and a particular analysis of this cohort revealed that the benefits of the combination of amlodipine and perindopril were maintained in those with diabetes.

Patients were treated with either the combination of the ACE inhibitor benazepril and calcium-channel blocker amlodipine or with benazepril combined with hydrocholothiazide. The primary end-point was the composite of death from cardiovascular causes, non-fatal myocardial infarction, non-fatal stroke, hospitalisation for angina, resuscitation after sudden cardiac arrest and coronary revascularisation.

Subgroup analyses did not find heterogeneity of the results in subjects with or without diabetes. There is no evidence to support a preference for ACE inhibitors or ARBs in the treatment of MS patients.

The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial ONTARGET 30 compared telmisartan with ramipril in patients at risk of cardiovascular events one-third with diabetes.

It found no difference in rates of cardiovascular events between the groups. It has been hypothesised that the fact that some ARBs act as modulators of the nuclear receptor PPAR-gamma 31 could be important in conferring additional metabolic benefits of these drugs.

Comparative studies of telmisartan, an ARB with a more potent ability to stimulate the PPAR-gamma receptor, against losartan, 32 irbesartan 33 and eprosartan 34 resulted in better metabolic outcomes, as measured by fasting glucose, insulin and lipids.

In the ONTARGET trial, however, rates of new-onset diabetes were no different in ramipril- or telmisartan-treated patients. Specific dietary interventions, such as sodium restriction or the adoption of the DASH diet, in addition to calorie restriction and increased exercise, could be helpful.

For patients with diabetes also receiving antihypertensive treatment, ARBs are able to prevent the development of microalbuminuria in normoalbuminuric patients 35 or overt proteinuria in those with microalbuminuria. ASCOT demonstrated that treatment with 10mg atorvastatin was effective in reducing cardiovascular events when hypertension was accompanied by three or more risk factors, including most contained in the definition of MS.

Two classes of drugs reduce triglycerides and increase HDL cholesterol. It is linked to insulin resistance. This is when your body does not respond to the hormone insulin properly.

It may also be linked to having too much fat around your tummy. If your GP or hospital specialist thinks you have metabolic syndrome, they will:.

They will usually arrange some blood tests to check your blood glucose and the fats in your blood, such as cholesterol. They may tell you not to eat or drink anything apart from water for up to 12 hours before the test.

Treatment for metabolic syndrome usually involves making changes to your lifestyle. The best way to prevent metabolic syndrome, to treat it and prevent complications is through a healthy lifestyle.