Metabolic syndrome

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Fabian Dupont is a freelance writer in the medical department. The human medicine specialist is already doing scientific work in Belgium, Spain, Rwanda, the USA, Great Britain, South Africa, New Zealand and Switzerland, among others. The focus of his doctoral thesis was tropical neurology, but his special interest is international public health and the comprehensible communication of medical facts.

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A metabolic syndrome (also: deadly quartet) is not an independent disease, but a combination of various diseases and symptoms. It is considered to be the most important risk factor for cardiovascular diseases. These are the most common cause of death in Germany and other industrialized nations. Read here what exactly the metabolic syndrome is, how it can be recognized and treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. E78E11E88I10E66

Metabolic syndrome: description

The term "metabolic syndrome" summarizes various factors that often lead to cardiovascular diseases. This includes:

severe overweight (obesity)
a disturbed fat and cholesterol balance
High blood pressure (arterial hypertension)
a pathologically increased blood sugar level due to insufficient insulin effect

These four risk factors are favored by the western lifestyle and play an important role in the development of vascular diseases. In the Anglo-American language area, the combination of these four partial diseases of the metabolic (prosperity) syndrome is also called "deadly quartet".

According to expert estimates, every fourth person in Germany will develop a metabolic syndrome in the course of their life. It is believed that this will double the risk of dying from a heart attack or stroke. In addition, a patient with metabolic syndrome is approximately five times more likely to develop diabetes (type 2 diabetes) if they do not take active action against these risk factors.

Metabolic syndrome is a major problem in the western world in particular, as it combines major health risks and causes high costs in health systems. Statistically, the incidence and mortality of the metabolic syndrome are far higher than, for example, those of HIV / AIDS. In Germany, cardiovascular diseases are responsible for around 40 percent of all deaths.

Metabolic Syndrome: Symptoms

The symptoms of Metabolic Syndrome often go undetected for a long time because it does not cause any pain or discomfort by itself. The doctor usually diagnoses it by chance during a check-up - or only after a heart attack or stroke.

The most important factor in metabolic syndrome is obesity. People who develop their love handles mainly on the stomach ("apple type", "beer belly", technical term: android obesity) are more at risk than those who are primarily well padded on the hips and thighs ("pear type", technical term: gynoids) Obesity). The vessels are damaged more by android obesity (also called "trunk-related obesity") than by gynoid obesity.

According to the Robert Koch Institute in Germany, 67 percent of men and 53 percent of women are overweight. 23 percent of men and 24 percent of women are even very overweight (obese).

The International Diabetes Association (IDF) has determined that the best way to assess obesity for metabolic syndrome is based on the size of the abdomen (this is the best way to identify dangerous trunk-related obesity). Often, however, the BMI (Body Mass Index) is also used.

The limit values for the waist circumference vary somewhat depending on ethnicity, but all range from a maximum of 102 centimeters for men and 88 centimeters for women. Above this value, according to the IDF definition, one speaks of trunk-emphasized obesity, the most important sign of a metabolic syndrome.

In order to be able to speak of a metabolic syndrome, at least two more of the following factors must be met:

disturbed lipid metabolism, measurable on the basis of increased blood lipid values. Patients who are already being treated for high blood lipids are also considered to be at risk.
low "good" cholesterol (HDL cholesterol)
increased arterial blood pressure. It can lead to headaches, dizziness, nosebleeds or a feeling of heat in the head, but it can also occur without symptoms. And as with a disturbed lipid metabolism, the following applies: Even if the treatment of high blood pressure has already started, this factor does not fall out of the risk assessment of the metabolic syndrome.
Insulin resistance (signs: increased fasting sugar in the blood) or manifest type 2 diabetes mellitus (most common form of diabetes).

All of these symptoms are the effects of a modern lifestyle, i.e. a lack of exercise and a poor diet (too many high-calorie foods).

Metabolic syndrome: causes and risk factors

It has not yet been conclusively proven what is the cause and what is the effect of the metabolic syndrome. However, researchers now assume that being overweight with too much belly fat, for example, increases the risk of developing metabolic syndrome. The typical "beer belly" is therefore considered to be the strongest promoter of the metabolic syndrome.

All aspects of the metabolic syndrome are related. In many cases there is a genetic predisposition to insulin resistance, which is promoted by an unhealthy lifestyle and can thus come to light (manifest). Since the insulin levels are then constantly high, there is an increased feeling of hunger - those affected eat excessively, which changes the blood lipid and cholesterol metabolism. Increased fat and cholesterol are deposited in the blood vessel walls (arteriosclerosis).

At the same time, in the metabolic syndrome, the excretion of salts - especially table salt (sodium chloride) - via the kidneys is disturbed. High levels of sodium in the body promote high blood pressure. This not only damages organs, but also promotes small injuries to the inner wall of the blood vessels. It is assumed that this also promotes the storage of fat and cholesterol. Over the years, the cardiovascular system is damaged more and more.

There are many other risk factors that can also increase cardiovascular risk. This includes smoking, for example.

Discussion of hereditary factors

Each person carries information for all metabolic processes in their genetic makeup. This information varies slightly from person to person, so that some people have an increased risk of developing metabolic disorders. Genetic factors are also assumed for the metabolic syndrome. Still, the most important influenceable factor remains lifestyle.

Metabolic syndrome: examinations and diagnosis

Ideally, a metabolic syndrome will be noticed as early as possible during a preventive examination and not only after a heart attack, stroke or any other consequence of vascular calcification (arteriosclerosis).

anamnese

To diagnose a metabolic syndrome, the doctor asks the patient about current symptoms in order to collect the medical history (anamnesis). He also asks whether the family has or are already suffering from cardiovascular diseases. Heart attacks or strokes in close relatives can be an indication of a tendency to metabolic disorders, which can ultimately lead to a metabolic syndrome.

Investigations

This is followed by a physical exam. Above all, it includes measuring blood pressure and the circumference of the abdomen.

During blood tests, blood sugar and blood lipid levels are measured. The blood sample required for this should be taken from the fasting patient. However, other blood values are also relevant: An increased uric acid level can indicate a metabolic syndrome. The liver values show whether a fatty liver has developed as a result of being overweight or as a result of poorly controlled diabetes.

Urine tests will also be done. An increased excretion of protein in the urine can, among other things, indicate kidney damage from high blood pressure or diabetes.

If no diabetes is known, but there are already indications of a disturbed sugar metabolism, an oral glucose tolerance test (oGTT) is carried out. The fasting blood sugar is measured at the beginning of the examination. Then the patient drinks a defined amount of a sugar solution. The blood sugar is measured again two hours after this sugar intake. Diabetes mellitus is present if the blood sugar level in the blood is more than 200 milligrams per deciliter (mg / dl) or 11.1 millimoles per liter (mmol / l). The cause is often the onset of insulin resistance. In order not to falsify the result, the examination must be carried out in the morning before the first meal.

With the help of electrocardiography (EKG) and ultrasound examinations (sonography), the doctor can determine whether there is already damage to the heart or other organs. If the blood vessels that supply the heart muscle are severely narrowed or after a heart attack, the ECG shows typical changes. With ultrasound technology, in turn, disorders of the myocardial contractions can be easily recognized.

Metabolic Syndrome: Treatment

If there is indeed a metabolic syndrome, the most important goal of treatment is to reduce the risk of consequential damage. The doctor will design an individual treatment plan together with the patient. It includes non-drug therapy measures and, if necessary, the use of medication.

American and Finnish studies have shown that even small partial successes can reduce the risk of serious secondary diseases or delay their occurrence.

Non-drug therapy measures

Non-drug treatment approaches consist primarily of a lifestyle change: more exercise and a balanced, low-fat diet are advisable.

This change in lifestyle and eating habits covers all four aspects of the metabolic syndrome at the same time and achieves the best treatment results. Many medical practices or health facilities offer training courses or patient information sheets to help those affected understand the clinical picture and to encourage them to cooperate.

The most important goal is a moderate weight reduction of around 10 to 15 percent during the first year. For this, patients should eat particularly low-carbohydrates and low-fat foods. You should also reduce your salt intake to counteract high blood pressure.

Weight reduction cannot be achieved solely through an adapted diet, it also requires more exercise: Dosed, regular endurance training (with a load of 60 percent of maximum performance) burns a lot of fat and at the same time makes the muscle cells more sensitive to insulin again.

New research results show that in addition to endurance training, short maximum loads such as sprints can improve the effect. But even small changes in lifestyle can achieve something: for many patients, getting to work by bike or on foot is the first step.

Medication

For people with an already derailed metabolism or a very high cardiovascular risk, the non-drug treatment must be supplemented by drug therapy:

Increased blood lipids: Fibrates and statins are some of the most important active ingredients in the treatment of high blood lipid levels. The substances help to lower the “bad” LDL cholesterol and to increase the “good” HDL cholesterol.
Increased blood pressure: So-called ACE inhibitors and AT1 receptor blockers reduce the tension in the wall of the arteries, so that the heart has to overcome less resistance when pumping the blood.
Insulin resistance and high blood sugar: Medicines such as metformin and acarbose increase the release of insulin from the pancreas and improve the effect of the hormone on the cells. Both contribute to the fact that sugar can be channeled from the blood into the cells - the blood sugar level drops.

Metabolic syndrome: disease course and prognosis

The metabolic syndrome is so dangerous because it only causes symptoms when it is almost too late. Vascular calcification (arteriosclerosis), heart attacks or strokes are events, the causes of which develop unnoticed over the years. The actual symptoms of an unhealthy lifestyle do not appear until many years after the triggering behavior. This often makes it more difficult for the patient to understand, because he does not feel sick and therefore in many cases does not see why he should adopt a healthier lifestyle. But this is urgently needed. The best treatment results can be achieved with exercise and a change in diet. Many studies have shown that such measures can do more than the use of drugs. A metabolic syndrome therefore requires very close and consistent cooperation between doctor and patient.

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