Metabolic syndrome X is a constellation of metabolic disorders that all result from the primary disorder of insulin resistance. All the metabolic abnormalities associated with syndrome X can lead to cardiovascular disorders - when present as a group, the risk for cardiovascular disease and premature death are very high.
The characteristic disorders present in metabolic syndrome X include:
- insulin resistance
- hypertension
- abnormalities of blood clotting
- low HDL and high LDL cholesterol levels
- high triglyceride levels
The chief abnormality present in syndrome X is insulin resistance. That is, the body's tissues do not respond normally to insulin. As a result, insulin levels become elevated in the body's attempt to overcome the resistance to insulin. The elevated insulin levels lead, directly or indirectly, to the other metabolic abnormalities seen in these patients.
Very often, the insulin resistance is severe enough that these patients eventually develop frank type 2 diabetes. When diabetes occurs, the high risk of cardiovascular complications goes even higher.
This condition is thought to run in families. The same families who have a history of type 2 diabetes are at risk for metabolic syndrome X. The family members at risk who actually go on to develop syndrome X are those who adopt sedentary lifestyles, and who become obese. In fact, metabolic syndrome X (like type 2 diabetes) can most often be prevented with exercise and weight loss.
Anyone with a family history of type 2 diabetes who is also overweight and who gets little exercise should be evaluated for the glucose, lipid and blood pressure abnormalities associated with syndrome X.
Treating the insulin resistance: While there is no drug treatment that directly reverses the insulin resistance that causes syndrome X, there is, in fact, a way to reverse the insulin resistance - diet and exercise. Patients should make every attempt to reduce their body weight to within 20% of the "ideal" body weight calculated for age and height. (The ideal diet for this condition is a low calorie, low-cholesterol diet with plenty of fruits, vegetables, and fiber.) And patients should incorporate aerobic exercise (at least 20 minutes) into their daily lifestyle. If both of these can be accomplished, most of the metabolic abnormalities seen in syndrome X substantially improve.
However, human nature (and human metabolism) being what it is, the majority of patients with syndrome X cannot accomplish these goals. In these cases, each metabolic disorder associated with syndrome X needs to be treated individually, and aggressively.
Treating the lipid abnormalities: The lipid abnormalities seen with syndrome X (low HDL, high LDL, and high triglycerides) respond nicely to weight loss and exercise. Treatment should be aimed primarily at reducing LDL levels according to the latest NCEP recommendations - recommendations based on a calculation of the individual's overall risk for a cardiovascular event. (Click here to review risk assessment.) Once reduced LDL targets are reached, efforts at reducing triglyceride levels and raising HDL levels should be made. Successful drug treatment usually requires treatment with a statin or one of the fibrate drugs, or a combination of a statin with either niacin or a fibrate.
Treating the clotting disorder: Patients with syndrome X have several disorders of coagulation that make it easier to form blood clots within blood vessels. These blood clots are often a precipitating factor in developing heart attacks. Patients with metabolic syndrome X should generally be placed on daily aspirin therapy to help prevent such clotting events.
Treating the hypertension: High blood pressure is present in more than half the people with metabolic syndrome X, and in the setting of insulin resistance, high blood pressure is especially important as a risk factor. Recent studies have suggested that successfully treating hypertension in patients with diabetes can reduce the risk of death and heart disease by a substantial amount.
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