Metabolic syndrome is a cluster of risk factors (central obesity, high blood pressure, high blood sugar, high triglycerides and low HDL) that raises the risk of heart disease, stroke and type 2 diabetes. Insulin resistance sits at its center, and the diagnosis needs 3 of the 5 criteria.
Key symptoms
- Often no symptoms at all
- Weight gain around the waist
- Tiredness, snoring or poor sleep
- Thirst or frequent urination if glucose is high
- Dark, velvety skin on the neck or armpits
What you find on exam
- Waist circumference: 102 cm or more in men, 88 cm or more in women
- Blood pressure of 130/85 or higher
- BMI and weight trend
- Acanthosis nigricans and skin tags
- Signs of fatty liver or sleep apnea
Tests
- Fasting glucose of 100 mg/dL or more, or HbA1c
- Lipid panel: triglycerides 150 mg/dL or more, HDL under 40 in men or under 50 in women
- Liver enzymes, kidney function and urine albumin
- 10-year heart risk calculation
Treatment basics
- Lifestyle first: 5 to 10 percent weight loss, 150 minutes of activity a week and a healthy diet
- Treat each factor: blood pressure drugs, a statin, metformin when indicated
- GLP-1 receptor agonists such as semaglutide for obesity
- Stop smoking, limit alcohol and treat sleep apnea
- Regular follow-up to track progress
Red flags
- Chest pain or stroke symptoms
- Blood pressure of 180/120 or higher
- Very high glucose with dehydration or confusion
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Sources: NCCPA PANCE Content Blueprint; AHA Scientific Statement, Measurement of Blood Pressure in Humans (Hypertension, 2019); AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.