Is This Disease For Real?

Metabolic syndrome may put you at higher risk for heart disease and diabetes, but many doctors question the diagnosis

As you read this article, you may be feeling pretty good about your health. Sure, your blood pressure is a little high, and your HDL reading (otherwise known as the "good" cholesterol) is low. But you are far from obese, despite that spare tire around your waist, and none of these problems on their own seem serious.

You'll be shocked, then, if during your next checkup, your doctor says you are at heightened risk of developing heart disease and diabetes. Suddenly, you don't just have high blood pressure or low HDL . You have metabolic syndrome, a disease that seems to be sweeping the nation -- even though the diagnosis is controversial.

Metabolic syndrome, sometimes called syndrome X, was first defined in 1988 as a collection of health risks that may increase the chances of developing cardiovascular disease two-and-a-half to four times, and diabetes by four to six times. Besides abdominal fat, high blood pressure, and low HDL levels, the basket of risk factors that can lead to a diagnosis includes insulin resistance and high triglyceride levels. To be tagged with the diagnosis, all you need is three out of five, and plenty of people meet the standard: Recent surveys estimate that as many as 25% of all Americans, and 44% of those age 50 and older, have metabolic syndrome. The number of prescriptions written for metabolic syndrome jumped 36% between 2002 and 2004, says consulting firm Medco Health Solutions.

Those prescriptions, however, are for the same blood pressure and cholesterol management pills that patients would be given if they weren't labeled with this particular diagnosis. In fact, there's no proof that a combination of risk factors is any more dangerous to your health than each factor considered separately. That makes the notion of metabolic syndrome as a distinct disease confusing to patients and doctors alike.

This lack of clarity has led to a face-off between cardiologists and endocrinologists over the validity of metabolic syndrome as a diagnosis, with each group issuing diametrically opposed statements. The American Diabetes Assn. (ADA) said in August that metabolic syndrome is "poorly defined, inconsistently used, and in need of further research." Dr. Richard Kahn, chief medical officer of the ADA, insists that metabolic syndrome, "doesn't exist. There is no scientific evidence proving that this is a distinct disease."


On the other side, the American Heart Assn. (AHA) issued a report in September stating that "metabolic syndrome is an important issue for physicians and the general public." The AHA strengthened its criteria for the disease, and for added heft it issued those criteria in partnership with a division of the National Institutes of Health.

What's a patient to make of all this? The answer, say many experts, is to worry about the risk factors, not the label. "From a practical point of view, this diagnosis tends to get people's attention," says Dr. Roger Blumenthal, director of Johns Hopkins Ciccarone Preventive Cardiology Center. "Most doctors think this is a good way to focus the patient on the overall problem."

That problem is a collection of seemingly unrelated health measurements. According to the AHA, metabolic syndrome exists if a patient meets any three of these criteria:

• A waist circumference of 40 inches or more in men and 35 inches or more in women, independent of overall weight

• A triglyceride level of 150 milligrams per deciliter (mg/dl) of blood

• HDL-cholesterol levels of 40 mg/dl or lower in men and 50 mg/dl or lower in women

• Blood pressure above 130/85

• Elevated glucose levels

None of these factors is considered more serious than the others. Nor do doctors know if any one could lead to another. But there is a growing sense that abdominal fat, the kind that globs up around the internal organs, is an obvious warning signal because it can release all kinds of chemicals that interfere with proper metabolism. One study even found that overweight women whose fat collected in the thighs and hips were healthier than women with lower body mass but large waists. Don't be fooled by a slender waist, however. You can still have metabolic syndrome if three of the other risk factors are present.

As for treatment, cardiologists, endocrinologists, and the American Association of Family Physicians all agree that lifestyle changes are the preferred method. "Dieting and moderate exercise are the best things you can do," says Dr. Rita Louard, director of the Clinical Diabetes Program at Montefiore Medical Center in New York. "And those are the hardest things we ask people to do."

The good news is you don't need to lose lots of weight to see an improvement. A diabetes prevention trial in Finland found that, in a group of middle-aged overweight men and women, losing 8 to 12 pounds over two years, reduced the risk of developing diabetes by 58%. Ideally patients diagnosed with metabolic syndrome should get within 20% of their ideal weight and aim for 15 to 30 minutes of brisk activity a day.

If such lifestyle changes are unlikely, a variety of drugs -- with a slew of side effects -- address each risk factor. The Mayo Clinic lists five categories for metabolic syndrome: weight-loss drugs, aspirin, insulin sensitizers such as Glucophage, blood pressure medicines such as ACE inhibitors and diuretics, and statins for regulating cholesterol.

There is a single drug on the horizon that some specialists say may be useful against the disease. Acomplia is awaiting Food & Drug Administration approval as a diet drug that blocks hunger cravings, but developer Sanofi-Aventis (SNY ) is also positioning it as a potential treatment for metabolic syndrome. That may be a long shot, Louard cautions: "I don't think one drug is going to do it. If I were going to have one message, it's that we as a society have to be aggressive on lifestyle modification." A hard message, but an increasingly necessary one.

By Catherine Arnst

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