Metabolic syndrome

Disease Description (Causes and Symptoms)

• Definition: A condition in which obesity, including abdominal (visceral) fat, is accompanied by metabolic abnormalities such as hypertriglyceridemia, low HDL, hypertension, and elevated fasting blood glucose, increasing the risk of cardiovascular disease and diabetes.
• Main causes and pathophysiology:
  • Insulin resistance is presumed to be the core pathological mechanism.
  • Inflammatory cytokines and adipokines secreted by visceral adipose tissue interfere with insulin action and cause hyperinsulinemia, dyslipidemia, and elevated blood pressure.
  • As a result, atherosclerosis progresses, and vascular inflammation and the tendency toward coagulation increase.
• Main symptoms:
  • Mostly asymptomatic (the syndrome itself does not have clear symptoms). The most noticeable sign is abdominal obesity (increased waist circumference).
  • Symptoms and complications related to the components (hypertension, hyperglycemia, and dyslipidemia) may occur separately.

Treatment Methods

• First-line treatment (priority principle): Lifestyle modification
  • Weight loss (especially reduction of visceral fat): Losing 5–10% of total body weight can improve metabolic health.
  • Diet: Calorie restriction; limit refined carbohydrates and sugars; reduce saturated and trans fats; consume vegetables, whole grains, fish, and unsaturated fats (the Mediterranean diet is effective).
  • Exercise: At least 150 minutes of moderate-intensity aerobic exercise per week + strength training twice a week is recommended.
  • Quit smoking, limit alcohol consumption, and improve sleep (evaluate and treat sleep apnea).
• Drug treatment (treatment targeting individual components)
  • Hyperlipidemia: Statins (with priority given to reducing cardiovascular risk); if necessary, control triglycerides with fibrates, omega-3, and other agents.
  • Blood pressure: ACE inhibitors/ARBs (with metabolic and kidney-protective effects), calcium channel blockers, diuretics, and others are selected according to the clinical condition.
  • Blood glucose and glucose tolerance: When diabetes is diagnosed, standard diabetes treatment (including metformin, SGLT2 inhibitors, and GLP-1 receptor agonists). In prediabetes, lifestyle modification is the priority; metformin may be considered in some patients.
  • Weight-loss medication: If lifestyle modification is insufficient, consider drug treatment such as GLP-1 receptor agonists (e.g., semaglutide). In cases of severe obesity, consider bariatric surgery (when the criteria for bariatric surgery are met).
  • Other: Adjunctive treatments such as aspirin are evaluated individually according to 10-year and lifetime cardiovascular risk.
• Procedures/Surgery:
  • Bariatric surgery (such as gastric bypass and sleeve gastrectomy) may be considered based on BMI and comorbidity criteria.
• Precautions (points to consider during treatment)
  • Lifestyle modification is fundamental, and medications are administered according to the target levels for each component.
  • When combining medications, interactions (e.g., the risk of muscle toxicity with statin + fibrate) and adverse effects must be monitored.
  • Cardiovascular and metabolic risk assessment is necessary before and after weight-loss medication or surgery.
• Follow-up and monitoring
  • Blood pressure: Measure at every visit.
  • Weight and waist circumference: Measure regularly (e.g., every 3–6 months).
  • Fasting blood glucose or HbA1c: At least once a year (more frequently in high-risk patients or those receiving treatment).
  • Lipid testing: At least once a year (more frequently during treatment); liver function tests and other tests as needed.

Checklist Before an Outpatient Visit (What to Bring and Preparation)

• What to bring:
  • A list of currently used medications (including prescriptions and OTC supplements) and the times they are taken.
  • Copies of recent test results, if available (blood glucose, HbA1c, lipids, liver function, kidney function, blood pressure records, etc.).
  • Records of weight, waist circumference, and blood pressure measurements (tracking records over several weeks, if possible).
  • Medical history (diabetes, hypertension, cardiovascular disease, sleep apnea, liver disease, etc.) and family history (cardiovascular disease, diabetes, etc.).
  • Notes on lifestyle habits (diet, exercise, alcohol consumption, sleep, and smoking).
• Important recent changes to tell the doctor about in advance during the outpatient visit:
  • Recent rapid weight change, breathing pauses (suspected sleep apnea), or the occurrence of symptoms such as chest pain, shortness of breath, or episodes of palpitations.
• Includes sample questions (for use in preparing for the consultation):
  • Show your recently measured blood pressure, weight, waist circumference, and test results and ask, “What level of risk do these values indicate for me?”

General Sample Questions to Ask the Doctor

• “What is my current 10-year and lifetime risk of cardiovascular disease (ASCVD)?”
• “What should I change first in my lifestyle? Can I receive specific dietary and exercise recommendations?”
• “Based on my current values (blood pressure, lipids, and blood glucose), do I need medication? What are the benefits and side effects of the medication?”
• “What are my treatment targets (blood pressure, LDL, fasting blood glucose/HbA1c)? How often should I have follow-up tests?”

Disease-Specific Sample Questions

• “In my case (providing my waist circumference, lipid levels, and fasting blood glucose level), should I start a statin immediately, or can I first manage it with lifestyle modification alone?”
• “I am having difficulty losing weight. Should I consider GLP-1-class weight-loss medication or bariatric surgery? What are the eligibility criteria for me?”

(Note: Example diagnostic criteria — metabolic syndrome is diagnosed when 3 or more of the following apply)

• Waist circumference (Asian criteria): Men ≥ 90 cm, women ≥ 80 cm
• Triglycerides (TG) ≥ 150 mg/dL
• HDL: Men < 40 mg/dL, women < 50 mg/dL
• Blood pressure ≥ 130/85 mmHg or currently taking antihypertensive medication
• Fasting blood glucose ≥ 100 mg/dL or currently taking blood glucose-lowering medication

Caution: The information above is general medical information; individual diagnosis and treatment should be determined in consultation with the attending physician.