# Metabolic Syndrome: How a Cluster of Risk Factors Connects Heart Disease and Diabetes

The metabolic syndrome is a cluster of metabolic risk factors that significantly raises a person's chances of developing both cardiovascular disease and type 2 diabetes. Affecting approximately one in four American adults, this increasingly common condition is driven largely by obesity and insulin resistance, and worsened by physical inactivity, aging, and genetic factors. The good news is that the primary treatment is within reach for most patients: lifestyle changes including weight loss, increased physical activity, and a heart-healthy diet can reduce every metabolic risk factor and slow progression to diabetes. As the condition advances, however, drug therapies targeting individual risk factors often become necessary.

# Metabolic Syndrome: How a Cluster of Risk Factors Connects Heart Disease and Diabetes

## Table of Contents

- Key Points
- What Is the Metabolic Syndrome and Why Does It Matter?
- The Five Key Risk Factors
- What Causes the Metabolic Syndrome?
- How the Concept of the Syndrome Evolved
- Health Outcomes: Heart Disease and Type 2 Diabetes
- How Doctors Diagnose the Metabolic Syndrome
- Why the Risk Is Greater Than the Sum of Its Parts
- The Debate Over the Name
- The Overlap With Prediabetes and Type 2 Diabetes
- Limitations as a Short-Term Risk Assessment Tool
- Lifestyle Modification: The Primary Therapy
- Drug Therapies and Emerging Treatments
- The Challenge of Multiple Medications
- The Pharmaceutical Industry Controversy
- Conclusions: What This Means for Patients
- Recommendations for Patients
- Study Limitations
- Frequently Asked Questions
- Source Information

## Key Points

- Metabolic syndrome affects about one in four American adults and raises risk of heart disease and type 2 diabetes.
- Diagnosis requires any three of five measures: waist, triglycerides, HDL, blood pressure, or fasting glucose.
- Lifestyle change, including weight loss, exercise, healthy diet, and smoking cessation, is the primary therapy.
- Drugs target individual risk factors but cannot fully reverse the syndrome's risk; lifestyle therapy is essential.
- About 86% of people with type 2 diabetes also have metabolic syndrome; intensive non-glucose risk management is critical.

## What Is the Metabolic Syndrome and Why Does It Matter?

Metabolic syndrome may sound like an intimidating medical term, but it describes a very common health condition with important consequences. It is a constellation of risk factors of metabolic origin that tend to travel together and dramatically increase the risk of developing two serious diseases: atherosclerotic cardiovascular disease (ASCVD)—which includes heart attacks, strokes, and blockages in the arteries—and type 2 diabetes.

This condition is far from rare. In fact, the metabolic syndrome occurs in approximately one-fourth of American adults. In 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) formally introduced the metabolic syndrome into cholesterol treatment guidelines as a "risk partner" to elevated LDL cholesterol. This step was taken in direct response to the rising prevalence of obesity and its metabolic complications in the United States.

Why does this matter so much? Because cardiovascular disease is the foremost killer of patients with diabetes. By identifying and treating this cluster of risk factors, the fields of cardiology and diabetes care can come together for a unified effort to reduce the risk of both conditions simultaneously.

## The Five Key Risk Factors

The metabolic syndrome is made up of a specific set of risk factors, all of which have a metabolic origin. Doctors look for the presence of these five conditions:

-
**Atherogenic dyslipidemia** — an unhealthy pattern of blood fats that includes elevated levels of apolipoprotein B-containing lipoproteins, high triglycerides, increased small particles of LDL cholesterol, and low levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol
-
**Elevated blood pressure** — readings that exceed normal levels
-
**Elevated plasma glucose** — blood sugar levels in the range of prediabetes or diabetes
-
**A prothrombotic state** — an increased tendency for blood to clot, caused by abnormalities in procoagulant factors such as fibrinogen and factor VII, increases in plasminogen activator inhibitor-1 (an anti-fibrinolytic factor), platelet aberrations, and endothelial dysfunction
-
**A proinflammatory state** — elevated levels of circulating cytokines and acute phase reactants, such as C-reactive protein, indicating ongoing low-grade inflammation

Having these risk factors together is far more dangerous than having just one. The metabolic syndrome concept was created because these factors cluster together so frequently and together predict both cardiovascular disease and diabetes with far greater power.

## What Causes the Metabolic Syndrome?

The causes of the metabolic syndrome are multifaceted. The two major underlying risk factors are **obesity** and **insulin resistance**.

Obesity—particularly abdominal obesity, identified by an increased waist circumference—is the strongest driver of the syndrome's growing prevalence. Insulin resistance, a condition where the body's cells don't respond properly to insulin, can be a consequence of obesity but also has genetic components. Several factors can make the syndrome worse: physical inactivity, advancing age, endocrine dysfunction, and genetic aberrations that affect individual risk factors.

One of the most important things to understand about the metabolic syndrome is that it is **progressive**. Most people who develop it first acquire abdominal obesity without any other risk factors. Over time, multiple risk factors begin to appear. At first, they are usually only borderline elevated. Later, they often become categorically raised—meaning they meet the formal thresholds for diagnosis of conditions like hypertension or diabetes.

The increasing prevalence of the metabolic syndrome in the U.S. and worldwide appears to be driven largely by obesity, which is made worse by sedentary lifestyles.

## How the Concept of the Syndrome Evolved

Our understanding of the metabolic syndrome comes from two different branches of research, each approaching the problem from its own angle.

Epidemiological studies have long established a strong association between obesity and both cardiovascular disease and type 2 diabetes. Some of that increased risk is due to well-recognized, obesity-induced risk factors like plasma cholesterol, elevated blood pressure, and diabetes—what researchers call the "metabolic complications of obesity."

The naming of the risk factor grouping as a "syndrome" came largely from the diabetes field. In particular, Dr. Gerald Reaven coined the term **"syndrome X"** to describe a constellation of metabolic risk factors associated with insulin resistance. Reaven and colleagues contended that insulin resistance is the dominant underlying risk factor. Others in the diabetes field adopted the name **"insulin resistance syndrome"**, viewing obesity as an exacerbating factor but giving it less pathophysiological significance than insulin resistance. Still others used "metabolic syndrome" as a more generic name for this aggregation of metabolic risk factors.

In 1998, a diabetes working group of the World Health Organization (WHO) proposed clinical diagnostic criteria requiring evidence of insulin resistance—such as impaired glucose tolerance, impaired fasting glucose, or type 2 diabetes—as necessary for diagnosis, plus two of four other components: elevated triglycerides or low HDL, elevated blood pressure, obesity, or microalbuminuria. Shortly afterward, the European Group for Study of Insulin Resistance (EGIR) proposed similar criteria.

In 2001, ATP III simplified these criteria by requiring just three of five simple clinical measures: increased waist circumference, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated glucose. Abdominal obesity was deliberately not made a requirement because some people with insulin resistance can have multiple metabolic abnormalities without overt abdominal obesity. The American Heart Association and the National Heart, Lung, and Blood Institute later reaffirmed the utility of the ATP III criteria with minor modifications. At the same time, the International Diabetes Federation (IDF) developed criteria close to ATP III but made waist circumference thresholds ethnic-specific and required abdominal obesity for diagnosis, simplifying diagnosis in developing countries where laboratory testing may be limited.

## Health Outcomes: Heart Disease and Type 2 Diabetes

The consequences of the metabolic syndrome are serious and well documented. In patients with the syndrome, the relative risk for atherosclerotic cardiovascular disease ranges from **1.5 to 3.0**, depending on the stage of progression. When diabetes has not yet developed, the risk of progressing to type 2 diabetes is, on average, about **five times higher** compared to people without the syndrome. Once diabetes develops, cardiovascular risk increases even further.

The natural history of the metabolic syndrome follows a predictable course in many patients:

1. Abdominal obesity appears first, often without any measurable risk factors
1. Multiple metabolic risk factors begin to develop, initially at borderline levels
1. Risk factors become categorically raised, meeting formal diagnostic thresholds
1. Many people progress to type 2 diabetes, which further increases cardiovascular risk
1. If cardiovascular disease develops, complications often follow—cardiac arrhythmias, heart failure, and thrombotic (clotting) episodes
1. Patients with diabetes may additionally develop a host of complications including renal failure, diabetic cardiomyopathy, and various neuropathies

When both cardiovascular disease and diabetes exist together, the risk for subsequent cardiovascular morbidity is very high.

The syndrome also frequently brings other conditions that complicate management: fatty liver, cholesterol gallstones, gout, and sleep apnea. The presence of several or all of these outcomes commonly leads patients to take multiple medications, a situation called **polypharmacy**.

## How Doctors Diagnose the Metabolic Syndrome

Diagnosing the metabolic syndrome is straightforward. According to the ATP III criteria, a diagnosis is made when a patient has **any three of the following five measures**:

-
**Elevated waist circumference**: ≥102 cm (≥40 inches) in men, or ≥88 cm (≥35 inches) in women
-
**Elevated triglycerides**: ≥150 mg/dL (1.7 mmol/L), or taking medication for elevated triglycerides
-
**Reduced HDL cholesterol**: <40 mg/dL (0.9 mmol/L) in men, or <50 mg/dL (1.1 mmol/L) in women, or taking medication for reduced HDL
-
**Elevated blood pressure**: ≥130 mmHg systolic or ≥85 mmHg diastolic, or taking medication for hypertension
-
**Elevated fasting glucose**: ≥100 mg/dL, or taking medication for elevated glucose

The most commonly used drugs for elevated triglycerides and reduced HDL are fibrates and nicotinic acid. A patient taking one of these medications can be presumed to have high triglycerides and low HDL.

Proper measurement of waist circumference matters. To measure it correctly, locate the top of the right iliac crest (the upper edge of the hip bone). Place a measuring tape in a horizontal plane around the abdomen at the level of the iliac crest. Before reading, ensure the tape is snug but does not compress the skin, and is parallel to the floor. The measurement is made at the end of a normal expiration.

One additional note: in the U.S., some adults of non-Asian origin (such as white, Black, and Hispanic individuals) with a marginally increased waist circumference (94 to 101 cm, or 37 to 39 inches, in men; 80 to 87 cm, or 31 to 34 inches, in women) might have a strong genetic contribution to insulin resistance. They should still benefit from lifestyle changes, just like people with higher waist measurements. For people of Asian origin, lower waist circumference cut points (≥90 cm, or 35 inches, in men; ≥80 cm, or 31 inches, in women) appear appropriate.

## Why the Risk Is Greater Than the Sum of Its Parts

Researchers have asked an important question: Is the cardiovascular risk associated with the metabolic syndrome simply the sum of its individual risk factors, or is it something more? The answer, based on multiple lines of evidence, is that **the risk is greater than the sum of its measured components**.

Here's why:

-
**Multiplicative risk**: Epidemiological studies strongly suggest that multiple risk factors raise risk more than the sum of the individual risk factors. Risk rises *geometrically* instead of linearly—meaning that risk factors multiply each other's effects rather than just adding together.
-
**Unmeasured risk factors**: Several metabolic risk factors are not included in standard risk algorithms, yet all appear to independently increase risk for cardiovascular events. These include a prothrombotic state, a proinflammatory state, and elevated triglycerides. This additional risk exceeds what can be explained by standard risk factors alone.
-
**Hidden risk behind established factors**: Some of the risk attributed to established factors like hypertension and low HDL can likely be explained by unmeasured risk factors. For example, blood-pressure-lowering drugs fail to reduce risk as much as predicted by epidemiological studies, suggesting that a portion of the hypertension-attributed risk is actually due to other unmeasured factors. Similarly, low HDL predicts cardiovascular risk so robustly in part because it serves as a marker for other metabolic risk factors.
-
**Progression to diabetes**: Because the metabolic syndrome often progresses and culminates in type 2 diabetes, the long-term risk of the syndrome is underestimated when measured at any single point in time.

## The Debate Over the Name

Interestingly, there is disagreement among experts about what to call this condition. The cardiovascular community has generally embraced the concept of risk-factor clustering as a "syndrome," even though the concept originated in the diabetes field. Cardiovascular investigators have been enthusiastic about the metabolic syndrome because it fits well with the multiple-risk-factor approach already used in risk management.

However, the name "metabolic syndrome" poses problems for some investigators in the diabetes community. Their concerns are threefold:

1.
**Insulin resistance as the dominant cause**: A group of researchers believes insulin resistance is the dominant cause of the syndrome and prefer the term "insulin resistance syndrome." The name "metabolic syndrome" leaves open the possibility of multifactorial causation, which counters their view of the essential pathogenesis. According to the insulin-resistance hypothesis, even obesity elicits metabolic risk factors through insulin resistance.
1.
**The prediabetes overlap**: The term "prediabetes," which encompasses impaired fasting glucose and impaired glucose tolerance, identifies people at elevated risk for type 2 diabetes. Yet approximately 70% to 75% of individuals with prediabetes also meet the clinical criteria for the metabolic syndrome. Some investigators argue that prediabetes carries similar predictive power for cardiovascular disease as the metabolic syndrome—though this is likely explained by accompanying metabolic risk factors. The significant overlap between prediabetes and the metabolic syndrome creates a tension over nomenclature within the diabetes world.
1.
**The type 2 diabetes identity question**: Both ATP III and IDF criteria allow a diagnosis of the metabolic syndrome to be applied to patients with type 2 diabetes who show a clustering of characteristic risk factors. This is not an academic issue—it has real clinical implications.

## The Overlap With Prediabetes and Type 2 Diabetes

The overlap between the metabolic syndrome and type 2 diabetes is extensive. According to the data, about 75% of people with prediabetes have the metabolic syndrome, and a striking **86% of people with type 2 diabetes** have it. The diabetes community faces significant identity issues because of this overlap—about 86% of persons over age 50 living in the U.S. who have type 2 diabetes will qualify for a diagnosis of the metabolic syndrome.

Research by Alexander and colleagues found that the metabolic syndrome, as defined by ATP III, accounts for most of the increased risk for coronary heart disease accompanying type 2 diabetes. This raises a deeper question: should type 2 diabetes be strictly defined as hyperglycemia caused by insulin resistance and decreased insulin secretion, or should it include the metabolic syndrome as one of its components?

The implications for patient care are significant. Cardiovascular risk factors in most patients with type 2 diabetes deserve greater clinical attention than they currently receive. Intensive management—including drug treatment for elevated cholesterol and blood pressure, not to mention hyperglycemia—is usually required. In addition, low-dose aspirin is typically recommended for most patients with type 2 diabetes to reduce the prothrombotic state.

Unfortunately, the author notes, many physicians who treat patients with type 2 diabetes have failed to recognize the necessity of substantially lowering cholesterol and blood pressure and adding aspirin prophylaxis. Clinical trials clearly document the benefit of intensive reduction of non-glucose risk factors—cholesterol and blood pressure—in patients with type 2 diabetes. This need is strongly stated in national cholesterol and blood pressure guidelines.

## Limitations as a Short-Term Risk Assessment Tool

While the metabolic syndrome carries increased long-term risk for both cardiovascular disease and diabetes, it is **not a reliable tool for short-term global risk assessment**—for example, predicting a person's 10-year risk of a heart attack or stroke. The syndrome does not include all of the risk factors contained in standard risk-prediction algorithms, such as age, gender, total cholesterol, and smoking status.

For that purpose, the ATP III guidelines recommend using established tools like the **Framingham risk scoring** algorithm. Still, people with the metabolic syndrome live on a higher trajectory of long-term risk for both ASCVD and type 2 diabetes, so the progressive nature of the syndrome must be recognized.

Even standard risk algorithms are limited in how well they predict risk for individuals. More effective prediction tools are needed. One promising technique is identification of atherosclerotic burden through **non-invasive imaging**. Finding significant atherosclerotic burden in patients who wouldn't otherwise be identified as high-risk could trigger more intensive interventions, such as cholesterol-lowering drugs and low-dose aspirin. Patients with the metabolic syndrome may be particularly good candidates for atherosclerosis imaging, although this strategy has not yet been fully developed.

## Lifestyle Modification: The Primary Therapy

When the ATP III guidelines embedded the metabolic syndrome into cholesterol guidelines, a central goal was to reinforce clinical lifestyle therapies. These therapies consist of:

- Weight reduction
- Increased physical activity
- An anti-atherogenic diet (a diet that works against artery-clogging processes)
- Smoking cessation (considered mandatory)

Lifestyle intervention is unfortunately often neglected in routine practice, but it has remarkable potential. It can reduce the severity of *all* metabolic risk factors at every stage of progression, as well as slow their progression over time. Drug therapies for established risk factors alone are not sufficient to completely reverse the risk associated with the syndrome.

Clinical trials consistently show a substantial "residue" of risk that cannot be reversed with drugs. Lifestyle modifications are one way to cut into this residual risk. Additionally, starting lifestyle interventions early in the syndrome can delay risk-factor progression and postpone the need for drug therapies. Beyond reducing cardiovascular risk, weight reduction and increased physical activity actually slow progression to type 2 diabetes in people with the metabolic syndrome. This combined effect—reducing both cardiovascular risk factors and the emergence of diabetes—doubly validates lifestyle intervention as the primary therapy.

## Drug Therapies and Emerging Treatments

As the metabolic syndrome progresses, drug therapies directed toward individual risk factors may be required. Currently, the only drugs approved for treating the syndrome's risk factors are those that target individual factors: lipid-lowering drugs, antihypertensive agents, hypoglycemic (blood-sugar-lowering) drugs, anti-platelet drugs, and weight-loss agents.

Several specific drug categories deserve mention:

-
**Weight-loss drugs**: Two medications—sibutramine and orlistat—were already approved by the Food and Drug Administration at the time of this paper. They improve all of the metabolic syndrome risk factors but produce only moderate weight loss.
-
**Rimonabant**: A newer and promising weight-loss drug, rimonabant is a selective cannabinoid receptor-1 (CB1) antagonist. Endocannabinoids—natural body chemicals that activate CB1 receptors in the hypothalamus and limbic forebrain—accentuate overeating (hyperphagia). Rimonabant suppresses this endogenous activation of the endocannabinoid system. The drug causes a 5% to 10% weight loss lasting up to two years and may have additional systemic effects that independently reduce metabolic syndrome risk factors.
-
**Fibrates**: These drugs independently reduce risk for cardiovascular disease by treating atherogenic dyslipidemia, possibly because of their anti-inflammatory properties.
-
**Thiazolidinediones (TZDs)**: These drugs lessen insulin resistance and modestly improve various metabolic risk factors. One clinical trial found a strong trend toward decreasing cardiovascular outcomes with the TZD pioglitazone.
-
**Dual PPAR agonists**: These investigational agents combine PPAR-alpha and PPAR-gamma agonism in a single drug, producing favorable effects on several metabolic risk factors simultaneously.

All of these drugs, despite their promise, face outcome hurdles before they can be approved for routine use in patients with the metabolic syndrome. Ultimately, it may become possible to develop drugs that simultaneously modify all of the risk factors at once. Such drugs are in development but had not yet reached the level of clinical practice at the time of this publication.

## The Challenge of Multiple Medications

Patients with metabolic syndrome often end up taking several medications at once—a situation known as polypharmacy. This is not just a minor inconvenience. Polypharmacy carries the risk of adverse drug interactions, interferes with patients' ability to adhere to their medication regimens, and for many patients imposes a prohibitive cost burden.

This reality underscores the importance of early and aggressive lifestyle intervention. Instituting lifestyle therapies early in the syndrome can delay risk-factor progression and the need for drug therapies in the first place.

## The Pharmaceutical Industry Controversy

When the ATP III guidelines included the metabolic syndrome, the pharmaceutical industry recognized it as a potential target for drug therapy. The idea of reducing multiple risk factors with a single drug or drug combination is obviously attractive and needed. Interestingly, one criticism leveled against the metabolic-syndrome concept is that the pharmaceutical industry has tried to take advantage of it to promote or develop new drugs.

The author addresses this criticism directly. New drug development need not detract from the priority given to lifestyle modification. Moreover, developing a drug that can substantially reduce multiple risk factors is a formidable scientific challenge. Some in industry hoped the scientific community would agree on a single criterion for the syndrome so regulatory agencies would accept that criterion and register a new drug for the metabolic syndrome. This hope is unrealistic—not because of the lack of a single criterion, but because regulatory agencies are unlikely to allow registration for new targets in the cardiovascular field without clinical end-point trials demonstrating real-world benefit.

## Conclusions: What This Means for Patients

The metabolic syndrome consists of a clustering of risk factors of metabolic origin that together are associated with higher risk for cardiovascular disease and diabetes. The syndrome occurs in approximately one-fourth of American adults. It is accompanied by insulin resistance, but its increasing prevalence is due largely to escalating obesity.

The good news is that simple clinical criteria are available to identify people most likely to have the syndrome. These individuals typically have several metabolic risk factors that are not measured in clinical practice routine—but that makes identifying the syndrome through its five diagnostic measures all the more valuable.

Primary treatment is lifestyle therapy. But as the condition progresses, drug therapies directed toward individual risk factors might be required. According to the author, it might ultimately be possible to develop drugs that simultaneously modify all of the risk factors—however, at the time of this writing, such drugs remain in development and have not reached the level of clinical practice.

## Recommendations for Patients

Based on this review, patients can take the following practical steps:

1.
**Know your numbers**: Ask your doctor to check your waist circumference, blood pressure, fasting glucose, triglycerides, and HDL cholesterol. If you have three or more abnormal values, you meet the diagnostic criteria for the metabolic syndrome.
1.
**Pursue weight loss**: Even modest weight loss improves all metabolic risk factors. This is the single most powerful lifestyle intervention for the metabolic syndrome.
1.
**Increase physical activity**: Regular exercise reduces the severity of metabolic risk factors and slows progression to type 2 diabetes.
1.
**Follow an anti-atherogenic diet**: Emphasize vegetables, fruits, whole grains, and healthy fats while limiting refined carbohydrates and unhealthy fats.
1.
**Quit smoking**: Smoking cessation is considered mandatory as part of lifestyle therapy.
1.
**Don't rely on the syndrome alone to estimate your short-term risk**: Ask your doctor to calculate your 10-year cardiovascular risk using a tool like the Framingham risk score, and discuss whether atherosclerosis imaging might be appropriate.
1.
**If you have type 2 diabetes, pay attention to more than just sugar levels**: Aggressive management of cholesterol, blood pressure, and aspirin prophylaxis is critical for reducing cardiovascular risk.
1.
**Take medications as prescribed but revisit lifestyle changes constantly**: Drugs for individual risk factors are important, but they cannot reverse all of the risk associated with the syndrome. Lifestyle modification attacks the residual risk that drugs leave behind.

## Study Limitations

This paper is a state-of-the-art review, meaning it synthesizes the available research and expert opinion up to 2006 rather than presenting a single new study. As the author acknowledges through the discussion of nomenclature debates, there is active disagreement within the scientific community about the underlying cause of the metabolic syndrome—whether insulin resistance is the dominant driver or whether obesity deserves equal pathophysiological standing.

The author also notes that the metabolic syndrome was not designed as a reliable tool for short-term global risk assessment and that drug therapies for the syndrome as a whole had not yet been approved—meaning some of the treatments discussed, such as rimonabant and dual PPAR agonists, were still in development and had not demonstrated long-term outcomes. Additionally, the review notes that even established risk algorithms have limitations in predicting risk for individuals, underscoring the need for better prediction tools such as atherosclerosis imaging.

Finally, lifestyle intervention is clearly identified as the foundation of treatment, but the author acknowledges that such intervention is often neglected in routine practice—a persistent challenge that remains relevant today. Readers should note that recommendations in this field have continued to evolve since this paper was published.

## Frequently Asked Questions

### What is metabolic syndrome?

Metabolic syndrome is a cluster of metabolic risk factors that significantly raises a person's chances of developing cardiovascular disease and type 2 diabetes. It affects about one in four American adults. It is driven largely by obesity and insulin resistance, and worsened by physical inactivity, aging, and genetic factors.

### How is metabolic syndrome diagnosed?

Doctors check waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose. You meet the diagnostic criteria if you have any three of five abnormal values. Examples include waist ≥102 cm (men) or ≥88 cm (women), blood pressure ≥130/85, and fasting glucose ≥100 mg/dL.

### What health problems can metabolic syndrome cause?

It raises the risk of heart attack, stroke, and type 2 diabetes. If diabetes hasn't developed yet, the risk of progressing to it is about five times higher compared to people without the syndrome. It can also bring fatty liver, cholesterol gallstones, gout, and sleep apnea.

### Can lifestyle changes help with metabolic syndrome?

Yes. Weight reduction, increased physical activity, an anti-atherogenic diet, and smoking cessation reduce the severity of all metabolic risk factors at every stage of progression. These changes also slow progression to type 2 diabetes and can delay the need for drug therapies.

### What medications are used for metabolic syndrome?

Drugs target individual risk factors: lipid-lowering drugs, antihypertensive agents, blood-sugar-lowering drugs, anti-platelet drugs, and weight-loss agents. They are important but cannot completely reverse the syndrome's risk. Lifestyle modification remains the primary therapy and attacks the residual risk that drugs leave behind.

### Can a second opinion change my metabolic syndrome treatment plan?

Treatment for metabolic syndrome focuses on lifestyle changes—weight loss, physical activity, an anti-atherogenic diet, and smoking cessation—which can reduce every risk factor. Drug therapies target individual risk factors and may be added as the condition progresses. Because experts disagree about the syndrome's underlying cause and the optimal approach, a second opinion can help ensure your plan addresses all five risk factors and any coexisting conditions like type 2 diabetes, where aggressive cholesterol and blood pressure management is critical. A second opinion can also clarify whether you need testing beyond the standard diagnosis, such as atherosclerosis imaging. Diagnostic Detectives Network provides independent expert second opinions.

## Source Information

**Original title:** "Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds"

**Author:** Scott M. Grundy, MD, PhD

**Publication:** Journal of the American College of Cardiology, Vol. 47, No. 6, 2006, pages 1093–1100. Published by Elsevier Inc., © 2006 by the American College of Cardiology Foundation. doi:10.1016/j.jacc.2005.11.046

**Author affiliations:** Center for Human Nutrition and Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

**Conflict of interest disclosure:** Dr. Grundy received research grants from Abbott, GlaxoSmithKline, Merck, and Kos, and served on the consultant/advisory boards for Pfizer, Sanofi, and Abbott.

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not replace individual medical advice from a qualified healthcare provider. Patients with concerns about the metabolic syndrome or their cardiovascular risk should consult their physician.


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