The "Deadly Quartet"of 21st century

 Dr. Annie Sawyer

 

The terms "metabolic syndrome," "insulin resistance syndrome,” dysmetabolic syndrome”,  “syndrome X",  Raven’s syndrome, CHAOS (in Australia) are now used specifically to define a  constellation of conditions or abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease (e.g. heart disease, coronary artery disease and stroke). 

This constellation of conditions can be also named the “Deadly Quintet”, due to the fact that Metabolic Syndrome can include type 2 diabetes (the most common type of diabetes mellitus), high blood insulin levels, high blood pressure, obesity and poor lipid profile (dyslipidemia) - elevated LDL (“bad”) cholesterol,  low HDL (“good”) cholesterol, and elevated triglycerides, with increased risk for clotting.

Metabolic syndrome comprises an accumulation of different and mutually intensifying diseases and risk factors, which mostly share the same causes. Metabolic Syndrome is actually is a cluster of disorders, all of which are affected by both genetics and lifestyle intrinsic and extrinsic factors. It affects a large number of people in a clustered fashion. In some studies MS is calculated as being up to 25% of the population in USA. 

Metabolic Syndrome increases the risk of type 2 diabetes (the most common type of diabetes) anywhere from 9-30 times that of the normal population and despite studies vary the risk of heart disease increases 2-4 times over the normal population.

There are also other concerns as well as fat accumulation in the liver (also known as fatty liver), resulting in chronic inflammation and the potential for degenerative cirrhosis. The kidneys can also be affected, as there is an association with microalbuminuria- the leaking of protein into the urine, a subtle but clear indication of kidney damage. Other problems associated with metabolic syndrome include obstructive sleep apnea, polycystic ovary syndrome (POOS), increased risk of dementia with aging, and rapid cognitive decline in the elderly.

What remains yet controversial is whether metabolic syndrome should be considered a coronary equivalent or not. The main features of metabolic syndrome include insulin resistance, obesity, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting.

Mechanism of appearance (Pathogenesis): An important pathogenic factor is the insulin-resistance which is often a consequence of increased obesity.  

Metabolic syndrome or the “Deadly Quartet” of 21 century is a cluster of: 

• Abdominal obesity (waist circumference( Men — waist greater than 40 inches; Women — waist greater than 35 inches
• Triglycerides — greater than 150 mg/dl
• HDL Cholesterol — less than 50 mg/dl in women, and less than 40mg/dl in men.
• Blood pressure — greater than 130/ 85 mm Hg
• Fasting glucose — greater than 110 mg/dl    

Tests:

• Fasting blood sugar or three-hour glucose tolerance test (diagnoses pre-diabetes)
• Hemoglobin A1c — if you have diabetes (measures chronic blood sugar control)
• Complete Iron panel — includes ferritin, tranferrin, iron-binding capacity and free iron level
• Cholesterol (with complete breakdown of subtypes)
• Triglycerides
• Independent risk factors: homocysteine, Lp(a), fibrinogen and CRP
• Blood pressure
• Waist measurement
• Urinalysis with screen for microalbuminuria