Obesity, altered glucose, high cholesterol, triglycerides, and high blood pressure, this dangerous cocktail, known as metabolic syndrome, leads to diabetes or cardiovascular diseases and affects more and more people.
What is metabolic syndrome? The answer is not simple because the pathophysiology (the study of the production mechanisms) of this syndrome is profoundly complex. We debated its definition, its real cause, and it’s true impact on cardiovascular health for several years. However, insulin resistance seems to be responsible for most of the abnormalities that constitute its etiology.
The latest definitions of scientific societies say that we understand metabolic syndrome as the clinical situation in which a subject presents three or more of the following conditions:
- Abdominal obesity ( abdominal circumference greater than 102 cm in men and 88 cm in women).
- Altered glucose (more than 110 mg/dl).
- Low HDL cholesterol (less than 45 mg/dl in men and 55 mg/dl in women).
- Increased production of triglycerides (more than 150 mg/dl).
- Elevated blood pressure ( systolic blood pressure greater than 130 or diastolic blood pressure greater than 85 mmHg).
Thus, the subject with metabolic syndrome may present three, four, or five of these risk factors, varying the intensity of each of them, which will confer a different, but always high, danger that their arteries will become ill.
There are somewhat inaccurate data on the prevalence of metabolic syndrome, depending on the populations studied. In general and in the western world, it is estimated that between 10-20% of the population suffers from this syndrome. T
There seems to be a clear relationship with age, in such a way that its prevalence increases considerably in the group of individuals over 60 years of age, where figures of more than 40% are considered in some Western societies. It is also true and alarming that there is a higher incidence in young people (between 20-30 years) compared to previous decades due to poor diet and decreased physical activity.
Origin of the metabolic syndrome: ‘the quintet of death.’
The metabolic syndrome comes from syndrome X, discovered and described by scientist Gerald Reaven in 1988, linking the relationship between insulin resistance and hyperglycemia, arterial hypertension and dyslipidemia as mediators of cardiovascular risk, and after observing that these three factors of risk tended to occur together in the same subject generally. Since the common denominator of these risk factors is insulin resistance, this syndrome has also been called insulin resistance syndrome.
In 1998 the WHO suggested metabolic syndrome for this group of alterations and proposed the first consensual definition.
It is curious and instructive that a concept as current as this of metabolic syndrome was already defined essentially more than eighty years ago (in 1927) by Dr. Gregorio Marañón. In his clinical wisdom, he came to write at that time: “HT is a pre-diabetic state… this concept also applies to obesity, and there must be some form of general predisposition for the association of diabetes with HT, obesity, and perhaps also with drop”. Likewise, someone years ago came to call it “The Quintet of Death,” parodying the famous classic Alexander MacKendrick film in the sense of the silent danger of the five assassins camouflaged with innocence.
Metabolic syndrome and cardiovascular disease
Cardiovascular diseases pose a constant and growing threat to the citizens of developed countries or developing countries. For many decades they have been the leading cause of death and disability, and in the coming years, far from correcting this importance, it seems that they will continue to attack our health. The metabolic syndrome, a dangerous combination of obesity, impaired glucose, high cholesterol, triglycerides, and elevated pressure behind its appearance in many cases.
Metabolic syndrome and cardiovascular disease, a problem of genes
But why does this phenomenon occur in so many people? The most satisfactory explanation is that it seems that our genes are designed for a much older time, some 100,000 years before, when man had great difficulty in getting to eat animal protein, which he did seldom and after intense and extensive physical exercises.
Our metabolism was then prepared to store the little energy that it could eat from the scarce game, accumulating fat, mainly in the abdominal area (the constant movement of the arms and legs prevented it from doing so there) to use it as a reserve store in the periods of lack.
With the arrival of the gatherer and livestock man, access to animal food became something simpler and more common. The hunger was disappearing for the majority and, Our genes are adapting to this new situation of easy food, with little effort. This situation has radically worsened in the last decades of industrialization, where the sedentary lifestyle of the population has reached epidemic dimensions. As you imagine, this problem will probably be solved in about 100,000 to 150,000 years, by which time our genome readjusts to our new way of living.
Insulin resistance
The situation of maximum risk, that is, of the greater danger of developing cardiovascular disease, is that which occurs when the subject suffers from a pathology that begins with a disorder called “cellular insulin resistance.”
In it, all cells need more insulin in the blood than normal to introduce the essential glucose through the cell membrane and thus maintain the proper functioning and metabolism of all body tissues and systems.
This insulin resistance condition is accompanied by other manifestations such as increased blood pressure and weight gain due to fat accumulation. Especially at the abdominal level, changes in fat metabolism causing an increase in the production of cholesterol and triglycerides, a decrease in cholesterol excretion, and an increase in blood glucose levels can lead to the development of diabetes.
The order of importance and protagonism in the creation and development of disease varies somewhat from one population to another. However, we know with certainty that when more than one of the factors above appears together, the danger of getting sick does not add up but multiplies.
How this accumulation of risk factors occurs is varied, but when we already have three or more of them, we say that we are dealing with a subject with the so-called “metabolic syndrome.” Its association with cardiovascular disease constitutes one of the most serious alterations with the greatest development and growth in recent times.
Metabolic syndrome and diabetes
Diabetes mellitus is a chronic metabolic disease, cataloged in recent years of epidemic proportions due to the alarming increase in its prevalence. It is directly related to the development of coronary disease and early atherosclerosis. Its etiopathogenesis (causes and mechanisms of a disease) is closely linked to the phenomenon of insulin resistance and is a link between the cardiovascular risk factors constituting the metabolic syndrome.
