Metabolic syndrome natural history, complications & prognosis


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]

Overview
Metabolic syndrome occurs in the presence of insulin resistance and accompanying obesity. It increases the risk for coronary heart disease, diabetes, fatty liver, stroke and some cancers. It may manifests as hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein cholesterol and abdominal obesity. It affects a large number of people in a clustered fashion. In some studies, the prevalence in the USA is calculated as being up to 25% of the population.

Complications
The complications found associated with metabolic syndrome are:


 * Cardiovascular complications
 * Coronary heart disease
 * Atrial fibrillation
 * Heart failure
 * Aortic stenosis
 * Stroke (ischemic)


 * Nonalcoholic fatty liver disease
 * Obstructive sleep apnea
 * Breast cancer
 * Cancers of the colon, gallbladder, kidney, and prostate gland
 * Psoriasis
 * Accelerated cognitive aging

Supportive trial data
===The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) ===
 * Source & year - The American Journal of Cardiology


 * Study question – Estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome


 * Study design – Post hoc determination of placebo data from the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) used to estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome.


 * Study results – In the Scandinavian Simvastatin Survival Study and AFCAPS/TexCAPS, respectively, Placebo-treated patients with the metabolic syndrome were-
 * 1.5 (95% confidence interval 1.2 to 1.8) times more likely to have MCEs than those without it in 4S
 * 1.4 (95% confidence interval 1.04 to 1.9) times more likely to have MCEs than those without it in 4S

The following risks factors increased the relative risks for MACE
 * Study conclusion
 * Low high-density lipoprotein levels were associated with elevated risk of MCEs in both studies
 * High triglycerides in the Scandinavian Simvastatin Survival Study
 * Elevated blood pressure and obesity in AFCAPS/TexCAPS were associated with significantly increased relative risk