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.

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.

What Causes Metabolic Syndrome

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.

More research is needed to fully understand the connections.

What are the signs and symptoms? Usually, there are 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.

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.

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:

• A large waistline or 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” cholesterol level 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.

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 plan such 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.

Medications may be needed if lifestyle changes alone aren’t enough to help make a difference. Several types of medications 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.

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 it onto my kids?