Metabolic syndrome
Clustering of central obesity, insulin resistance, dyslipidaemia and hypertension
Overview
A cluster of cardiometabolic risk factors — central obesity, raised fasting glucose/insulin resistance, raised triglycerides, low HDL and hypertension — that multiplies cardiovascular and T2DM risk. Managed by aggressive lifestyle change and treating each component.
Recognise
- Central (visceral) obesity with raised waist circumference; insulin resistance/acanthosis nigricans
- ≥3 of: central obesity, fasting glucose ≥5.6/IFG, triglycerides ≥1.7, HDL low, BP ≥130/85
- Associations: NAFLD, PCOS, hyperuricaemia/gout, obstructive sleep apnoea
Red flags
- Established CVD or T2DM → manage as secondary prevention / diabetes
Differentials & how to tell them apart
Investigations
Waist circumference, BP, fasting glucose/HbA1c, fasting lipids; assess for NAFLD, OSA.
Management
Intensive lifestyle change + treat each component (BP, lipids, glucose)
- 1Aggressive lifestyle modification (weight loss is the highest-yield intervention). Treat hypertension, dyslipidaemia and dysglycaemia per their pathways.Gate: Screen for and treat the comorbid clusters — NAFLD, OSA, PCOS, gout — which travel with it
- 2Statin and antihypertensive as indicated; metformin/diabetes therapy if progresses to T2DM; bariatric pathways for severe obesity.
Key points
It is a risk multiplier, not a disease per se — central obesity + the cluster. Exclude Cushing's/hypothyroidism/PCOS as drivers; weight loss reverses much of it.
Monitor & prognosis
CV risk factors; glucose progression.
Modifiable; predicts CVD and diabetes.
Source: IDF/NICE risk guidance