M1. Metabolic Syndrome

Metabolic Syndrome

It might sound like a single condition, but metabolic syndrome actually describes a clustering of risk factors for heart disease. These include carrying too much fat around your waist or having high blood pressure, elevated blood sugar levels, high triglycerides and/or low HDL (or good) cholesterol.

If you’ve been told that you have metabolic syndrome (sometimes called cardiometabolic syndrome), it means that you have several of these health problems. Together, they put you at much greater risk for heart attack, stroke and type 2 diabetes. In general, someone who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as a person who doesn’t have this grouping of health issues. Unfortunately, amid rising obesity rates in the U.S., this syndrome is becoming more common. Alarmingly, one out of 10 teens may have it.

The good news is that committing to living a healthier life over the long-haul can make a difference. Lifestyle changes—for example, getting exercise, losing weight, eating a heart-healthy diet and not smoking—can help delay or even prevent the development of serious health problems. It’s important to partner with your health team to map out steps to manage your risk.

Use this condition center to learn more about metabolic syndrome, create a list of questions to ask your health care provider and get practical tips.


Metabolic syndrome has been called the “perfect storm” when it comes to heart disease risk. It’s a combination of health problems—for example, carrying too much fat around your waist, high blood pressure, elevated blood sugar levels and abnormal cholesterol levels—that often occurs together and raises your risk of heart disease, stroke and diabetes. This clustering of risk factors happens because the body has a hard time regulating cholesterol (lipids), certain proteins and sugars (glucose).

It can be worrying to learn that you or a loved one has metabolic syndrome. The upside is that if it is found early, it can serve as an important warning and help put you on a heart-healthier path. Many lifestyle changes, including weight loss, can prevent and even reverse every component of metabolic syndrome, or delay the development of serious health problems.

“If we can catch these risk factors early on through blood tests and a physical exam, we can help reduce the risk that these patients will go on to develop heart disease and diabetes,” said Laura Ross, PA-C, Park Nicollet Heart and Vascular Center, St. Louis Park, Minn.

Metabolic Syndrome: The Plain Facts

  • 1 in 3 adults in the U.S. have metabolic syndrome.
  • People with metabolic syndrome are 3 times more likely to have a stroke or heart attack than those who don’t have it.
  • Most people with diabetes (85%) have metabolic syndrome.
  • It becomes much more common as we age; nearly half of adults over age 60 have it.
  • It may overtake smoking as the leading risk factor for heart disease.

Metabolic syndrome is “considered to be the driving force for a new cardiovascular disease epidemic,” according to the International Diabetes Federation. It has been steadily growing in prevalence, paralleling skyrocketing rates of obesity in the United States. There is also some suspicion that sedentary lifestyles may also play a role. For example, not exercising, working a desk job or sitting for long periods of time. So, all the more reason to get moving more—even 10-minute bursts can help make a difference.

Why Knowing Your Risk Matters

Untreated, metabolic syndrome can make a heart attack, stroke and type 2 diabetes much more likely. It can:

  • Result in too much sugar in the blood
  • Damage the lining of the coronary arteries (those that supply blood to your heart) and other arteries
  • Raise levels of triglycerides (a form of fat) in the blood
  • Lower levels of HDL or “good” cholesterol in the blood
  • Raise blood pressure
  • Promote fatty deposits in the liver
  • Interfere with insulin production, which may make diabetes more likely, along with related health issues including nerve, eye and kidney problems

Metabolic syndrome has also been linked to sleep apnea, polycystic ovary syndrome, infertility and dementia.

Infographic: Metabolic Syndrome

What causes it?

Metabolic syndrome is thought to be triggered by insulin resistance, wider waist circumference, genetics (a family history of diabetes or early heart disease), and inactive lifestyles, although more research is needed.

Am I at risk?

Most people with metabolic syndrome are overweight and tend not lead very active lives. It is also more common as we age and among:

  • Women around menopause
  • People who eat too many unhealthy simple carbohydrates — such as white bread, rice and pasta, white crackers as well as sweets (cookies, candy, cakes)
  • Smokers
  • Those with a family history of diabetes or metabolic syndrome

Certain ethnic groups (Mexican Americans in the U.S.) are more likely to have metabolic syndrome. It’s also fairly common for people with metabolic syndrome to have other conditions, including diabetes and insulin resistance, which happens when your body is unable to use insulin properly to remove glucose from your blood.

What are the signs and symptoms?

Usually none. Carrying too much weight around the abdomen, often described as having an “apple shape,” can be a sign.

Some people may have physical signs of insulin resistance—including dark patches of skin or skin tags. But this doesn’t always occur, and it is seen more in people of certain ethnicities.

Overall, medical problems related to metabolic syndrome develop over time. That’s why it’s important to know and understand your cardiovascular health numbers and what they mean.

How is it diagnosed?

Metabolic syndrome is often found based on a physical exam, including blood pressure and weight measurements, and blood tests.

While there is some difference of opinion between expert medical groups, in general you have metabolic syndrome if you have three or more of the following:

  • large waistlineor excess fat around your belly, which is more risky for heart disease than fat elsewhere on the body. This is also called central obesity, which is defined as having a waist size of ≥40 inches for men, ≥35 inches for women. Cutoffs may differ by ethnicity, so talk with your health care provider.
  • Serum triglycerides(a type of fat in the blood) of ≥150 mg/dL or if you’re on medicine to treat elevated triglycerides
  • Fasting blood sugar level≥100 mg/dL or if you already have type 2 diabetes
  • Borderline or high blood pressure: top number (systolic) ≥130 mmHg OR bottom number (diastolic) ≥85 mmHg or if you are taking blood pressure-lowering medication
  • Low HDL or “good” cholesterollevel of <40 mg/dL in men and <50 mg/dL for women; HDL cholesterol helps remove bad cholesterol from your arteries

The more risk factors you have, the greater your risk of dying from cardiovascular disease.

Preventing metabolic syndrome

Metabolic syndrome often can be prevented by losing weight, getting routine exercise and eating better. Talk with your health care team about your personal risk for cardiovascular disease. Together, you can come up with a plan to keep your heart as healthy as possible.

Managing metabolic syndrome

If you have metabolic syndrome, the main focus of treatment will be to prevent or reduce the risk of heart attack, stroke and type 2 diabetes.

Your health care team will start with lifestyle changes, and advise you on safe and healthy ways to lose weight through regular exercise and committing to a healthier diet.

  • Try to exercise at least 30 minutes a day most days. You should feel your heart rate climb. Swimming, biking and gardening all count. If you have a pedometer, use it to track the number of steps you take each day and aim for 10,000 or more.
  • Eat healthy. You may need to change the types of foods you eat and how they are prepared. It’s also important to be aware of portion sizes and restricting calories. Be mindful of what is on your plate, and ask whether you might benefit from a heart-healthy eating plansuch as the DASH diet, a healthy vegetarian diet, or the Mediterranean diet.
  • Limit alcohol.
  • Limit the simple carbohydrates: less white bread, less potatoes, white rice and pasta, and less sweets; replace with complex carbohydrates
  • Quit or don’t start smoking.
  • Manage stress.
  • Pay attention to your waistline. It may be useful to measure your midriff so that you know where you started, and can track your progress.

Measuring your waist

To correctly measure waist circumference:

  • Stand and place a tape measure around your middle, just above your hipbones.
  • Make sure tape is horizontal around the waist.
  • Keep the tape snug around the waist, but not compressing the skin.
  • Measure your waist just after you breathe out.

Source: CDC, DHHS

Medications may be needed if lifestyle changes alone aren’t enough to help make a difference. There are several types of medications to help control your blood pressure, blood glucose or blood cholesterol. For example, ACE inhibitors lower blood pressure, and they have also been shown to reduce insulin resistance. Metformin is used to help prevent diabetes in people with metabolic syndrome. Aspirin may be recommended to prevent the blood from becoming sticky and forming clots.

Talking with your health care team

Your heart team knows what’s best in terms of supporting your heart health. Learn all that you can about your personal risk for cardiovascular disease. Central to this is knowing certain numbers; that means keeping track of your:

  • Weight
  • Waist circumference
  • Blood pressure
  • Blood glucose
  • Blood cholesterol
  • Any other important measures

It’s also important to talk with your health care team about your exercise, sleep and eating habits. All of these can play a role in your overall and heart health.

Here are some questions you might want to ask about metabolic syndrome:

  • What metabolic syndrome risk factors do I have, if any?
  • What does this mean for my health?
  • What is my waist measurement and BMI?
  • How much weight should I be trying to lose?
  • What types of physical activity might be best?
  • Should I meet with a dietitian or nutritionist? Can you recommend someone?
  • Is there a certain heart-healthy eating plan I should follow?
  • How often should I get checkups/blood tests?
  • Will I need medication to help control any of my risk factors? If so, how does each work?
  • How does my family history affect my risk of getting metabolic syndrome or passing