Host: Dr. Linda Austin - Associate Dean for Communication Development, Professor of Psychiatry.
Guest: Dr. Pamela B. Morris – Cardiologist
Dr. Linda Austin : I am Dr. Linda Austin and I am Dr. Pam Morris and you are listing to Heart Sounds.Dr. Linda Austin:Today we are going to talking about metabolic syndrome. Pam lots of people are hearing that terms and some are even getting that diagnosis. Just what is metabolic syndrome?
Dr. Pamela B. Morris: Well, the metabolic syndrome is a group of risk factors for heart disease and diabetes that tend to occur together. Their diagnoses or medical problems that always seem to travel together.
Dr. Linda Austin: I at least often thing that when one is over weight the odds of having metabolic syndrome, getting that diagnosis are great, is that true?
Dr. Pamela B. Morris: Yes, the metabolic syndrome is most common in people who have a belly fat are overweight, but most of the weight seems to cluster around their stomach area.
Dr. Linda Austin: So, are there formal symptoms or signs that you look for in order to make that diagnosis?
Dr. Pamela B. Morris: There are five, what we call criteria and if you have three out of the five criteria then you end up being diagnosed with a metabolic syndrome.
Dr. Linda Austin: So let’s take those one by one. What’s the first one?
Dr. Pamela B. Morris: The first one; it would be obtained from taking a measurement of your cholesterol profile and that’s your good cholesterol. As you know, if the good cholesterol or HDL can be protective against a heart disease and what we find if that good cholesterol is too low, it can be associated with other metabolic problems.
Dr. Linda Austin: I always remember that high should be high and low should be low.
Dr. Pamela B. Morris: That’s a good way, that’s an easy way to remember.
Dr. Linda Austin: Is there an absolute number for the HDL?
Dr. Pamela B. Morris: Yes, the HDL should be greater than 50 in women and greater than 40 in men.
Dr. Linda Austin: So that’s been somewhat of a moving target like many of the cholesterol goals these days. Every time you think you get a normal value, you find out they have changed the normal values, but in any event, right now it’s the metabolic syndrome could be present if a woman has an HDL of less than 50 and a man has an HDL of less than 40.
Dr. Linda Austin: What’s the second potential symptom or sign actually?
Dr. Pamela B. Morris: That would be triglycerides. Again, the nice thing about that it can be obtained from the same cholesterol profile that you would have had measured for the HDL. The triglycerides in both men and women should be less than 150.
Dr. Linda Austin:What’s the third sign?
Dr. Pamela B. Morris: Blood pressure; blood pressure, we all know that the diagnosis of high blood pressure is a blood pressure of greater than 140/90, but we have also heard a lot about this prehypertension that is you are beginning to develop high blood pressure, but not quite there yet. Those people often times have the metabolic syndrome, so if your blood pressure is greater than 130 on the top and 85 on the bottom then there is a possibility that you would have the metabolic syndrome.
Dr. Linda Austin: But if you’re someone, who has always had very low blood pressure like say a 110/70 and it begins to creep up, but now you’re at 120/80, is that a sign that you may be headed in that direction?
Dr. Pamela B. Morris: Correct, and it’s interesting. I don’t think we all aware of this statistic that if you take individuals that are 55 years of age and have a normal blood pressure, 85% of people, who have normal blood pressures at age 55 will eventually become hypertensive as they get older. It’s kind of a nature of our species as we get older, our arteries tend to stiffen and a variety of things happen, but the vast majority of us will ultimately develop high blood pressure. The key is to recognize and then have it treated in a timely fashion.
Dr. Linda Austin: So then, what’s the fourth sign?
Dr. Pamela B. Morris: The fourth sign is related to your waist circumference and what I mean by that is basically your waist measurement and I also want to point out, this must be measured properly because many folks who are overweight consider their waist size to be their belt size and what they do is they lift up their potbelly and put the belt underneath and then that qualifies as their waist size. In reality, an accurate measurement of your waist circumference has to be measured at your hip bones, so right at the top of your hip bone with the tape measure parallel to the floor and you can’t lift up your belly to make it small.
Dr. Linda Austin: And you can’t suck in your stomach.
Dr. Pamela B. Morris: That you can’t suck in your stomach. What you do is you take a nice deep breath and then just gently exhale and at the end of exhalation or after you have breath out then that is your actual waist measurement.
Dr. Linda Austin:And what is that number?
Dr. Pamela B. Morris: That should be less than 35 inches for women and less than 40 inches for men.
Dr. Linda Austin: Okay, so now what is the fifth sign?
Dr. Pamela B. Morris: The fifth sign is the blood sugar and that number should less than 100 for both men and women. So, if your blood sugar is 100 or higher then that is one of the criteria for the metabolic syndrome.
Dr. Linda Austin: So then let’s imagine you have at least three of these things and you now have this diagnosis of the metabolic syndrome. What does that really mean, why is that different than if you had only one, or what’s so significant?
Dr. Pamela B. Morris: It’s interesting, I get asked that question a lot because I am a cardiologist and people will say you know, why do you care about my waist measurement or why do you care about my blood sugar? Well, the interesting thing is that the metabolic syndrome increases the risk for developing diabetes and also significantly increases your risk for heart attack or stroke. So, in reality the metabolic syndrome is a precursor or a predictor of your risk of heart attack or stroke.
Dr. Linda Austin: But then it would seem to me that if you have one of those factors, you are maybe starting to walk down that path, not too late to turn back and go to the other direction, but it surely it’s not an all or none thing that you suddenly have increased, vastly increased risk with three.
Dr. Pamela B. Morris: Right
Dr. Linda Austin: That even two signs would be of concern.
Dr. Pamela B. Morris: That’s right and there is actually been some debate as to whether or not the fact that these cluster together. Does it really mean anything more than just adding 1+1+1 and the fact of the matter is when they occur together they seem to be synergistic; that is, it’s not a simple one risk factor plus one risk factor equals two risks factors worth of risk. In reality kind of 1+1 equals 3 or 4 or 5. The more you have, the risk seems to go up; exponentially it goes up greatly.
Dr. Linda Austin: Explain a little bit more if you would about this belly fat issue. Why is belly fat worse than having a big rear end for example.
Dr. Pamela B. Morris: Well, the fat in your abdomen or your belly behaves very differently from fat on your thighs or fat on your rear end. That type of fat seems to make your body have a problem with handling blood sugar and insulin. Your body needs to use insulin to affectively get blood sugar into your muscles to be used for energy. What happens is, when you have a lot of fat in your belly or your abdomen, your muscles and your body seems to be resistant to the insulin that you are making. It’s not responding the way it should and that begins to cause problems with handling blood sugar and also in ways that we don’t completely understand yet, seem to affect things like blood pressure and also your cholesterol values.
Dr. Linda Austin: So, how often should people get these factors checked? Let say if you feel like you are a normal healthy person.
Dr. Pamela B. Morris: Well, for most of those things, for a normal healthy person, it’s probably on at least an annual basis. If one of those things begins to become abnormal then your physician will probably recommend that you be screened more regularly. If one of those features is abnormal, your blood pressure is kind of borderline or your blood sugar is borderline, then it would be important to have all five of those numbers measured to see how many of the criteria that you meet.
Dr. Linda Austin: Pam thanks so much for talking about this today.
Dr. Pamela B. Morris: Thank you.
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