Exercise and Diet

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The Metabolic Syndrome

Evidence is accumulating that risk for CHD can be reduced beyond LDL-lowering therapy by modification of other risk factors. One likely secondary target of therapy is the metabolic syndrome, which represents a set of lipid and non-lipid risk factors. This syndrome is closely linked to a generalized metabolic disorder called insulin resistance in which the actions of insulin are impaired. Excess body fat (particularly abdominal obesity) and physical activity promote the development of insulin resistance, but some are also genetically disposed to insulin resistance.

Clinical Identification of the Metabolic Syndrome in Women

Risk Factor Defining Level
Abdominal Obesity Waist Circumference
>88 cm (>35 inches)
Triglycerides >150 mg/dL
HDL cholesterol <50 mg/dL
Blood pressure >130/>85 mm Hg
Fasting glucose >110 mg/dL

When three or more of the risk determinants are present, the diagnosis of the metabolic syndrome is made. Management of the metabolic syndrome has the following goals: 1) to reduce the underlying causes (obesity and physical inactivity) and 2) to treat associated nonlipid and lipid risk factors.

Benefits beyond LDL lowering

The Adult Treatment Panel (ATP) recommends a multifaceted lifestyle approach to reduce risk for CHD. This approach is designated therapeutic lifestyle changes (TLC). It features include: 1) Reduce intakes of saturated fats (<7% of total calories) and cholesterol (<200 mg per day), 2) weight reduction and 3) increased physical activity. Management of underlying causes of the metabolic syndrome are weight reduction and increased physical activity, which will effectively reduce all of the rest of the risk factors. Therefore after appropriate control of LDL cholesterol, TLC should stress weight reduction and physical activity.

Weight control. Weight reduction will enhance LDL lowering and reduce all of the risk factors of the metabolic syndrome. The recommended approaches for reducing overweight and obesity are contained in the clinical guidelines of the NHLBI Obesity Education Initiative.

Physical activity. Regular physical activity reduces very low-density lipoproteins (VLDL) levels, raises HDL cholesterol, and in some person, lowers LDL levels. It can also lower blood pressure, reduce insulin resistance, and favorably influence cardiovascular functions.

Adapted from "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)", May 2001.