Metabolic syndrome, US top five health problems

The metabolic syndrome is characterized by a group of metabolic risk factors in one person.

Americans with metabolic syndrome a condition marked by big waistlines, diabetes, high blood pressure and cholesterol problems account for $4 of every $10 spent on prescription drugs for adults, according to a study.

The report by Medco Health Solutions, a huge prescription benefit manager, shows that adult use of medication for the syndrome jumped 36 percent between 2002 and 2004.

Annual prescription costs for people 20 and older with metabolic syndrome averaged $4,116 last year, 4.2 times the average amount spent on drugs for that age group, according to Medco.

Medco reached its findings by studying prescription records from a random sample of 2 million clients.

Dr. Robert Epstein, Medco’s chief medical officer, calls metabolic syndrome one of the country’s top five health problems.

The syndrome once called Syndrome X was first recognized about 40 years ago, but the term “metabolic syndrome” did not come into wide use until the last decade. The first international symposium on the syndrome was held three weeks ago in Berlin.

Metabolic syndrome is caused by the body’s inability to use insulin efficiently, and the hallmark of the condition is excessive abdominal fat. Patients also have two or more related conditions, including high blood pressure, low levels of good cholesterol, high levels of blood fats called triglycerides, and high blood sugar. Many have diabetes or will eventually.

Diabetes is a major treatment area for Eli Lilly and Co. Lilly generated $2.6 billion in sales from insulin and diabetes care products last year.

People with metabolic syndrome are twice as likely to suffer a heart attack or stroke and more than three times as likely to die early from those causes.

According to various U.S. estimates, at least one in four adults and roughly one in eight children have metabolic syndrome, with overeating and inactivity being key causes.

The prevalence in people over 40 jumped more than 60 percent over the past decade, federal health surveys show.

Dr. Stuart Weiss, director of the Diabetes Education Center at New York University, said naming the syndrome has brought more aggressive treatment for some patients and prevented cases of diabetes and heart disease.

New guidelines from the International Diabetes Federation are being reviewed by health agencies around the world to standardize the criteria for diagnosing the condition and help family doctors spot the syndrome and start treatment early.

“There aren’t enough heart specialists and diabetes specialists to handle all the cases worldwide,” said Dr. Paul Zimmet, co-chairman of the guidelines committee.

Medco is launching a service this summer to alert clients taking drugs for multiple components that they should be checked for the syndrome.

Medical groups are pushing for family doctors to be more aggressive in testing patients for metabolic syndrome and starting treatment early.

What is the metabolic syndrome?

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:
1. Central obesity (excessive fat tissue in and around the abdomen)
2. Atherogenic dyslipidemia (blood fat disorders — mainly high triglycerides and low HDL cholesterol — that foster plaque buildups in artery walls)
3. Raised blood pressure (130/85 mmHg or higher)
4. Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
5. Pro-thrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor [–1] in the blood)
6. Pro-inflammatory state (e.g., elevated high-sensitivity C-reactive protein in the blood)

The underlying causes of this syndrome are overweight/obesity, physical inactivity and genetic factors. People with the metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

Who has the metabolic syndrome?

The metabolic syndrome has become increasingly common in the United States. It’s estimated that about 47 million U.S. adults have it.

The syndrome is closely associated with a generalized metabolic disorder called insulin resistance, in which the body can’t use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome.

Some people are genetically predisposed to insulin resistance. Acquired factors, such as excess body fat and physical inactivity, can elicit insulin resistance and the metabolic syndrome in these people. Most people with insulin resistance have central obesity. The biologic mechanisms at the molecular level between insulin resistance and metabolic risk factors aren’t fully understood and appear to be complex.