A far more serious threat called ‘metabolic syndrome’

The metabolic syndrome or MS is an imminent threat in the Philippines and the rest of Asia, much worse in magnitude than the SARS (Severe Acute Respiratory Syndrome) threat. It is most likely a result of the "eat all you can, and drink all you can" mentality.

Whereas SARS has infected only several thousands worldwide, killing less than a thousand so far, millions are afflicted with the metabolic syndrome and hundreds of thousands are dying each year from its complications. And yet, not much is known of this "killer syndrome" unlike the much-hyped "killer pneumonia."

These and other findings and recommendations on the metabolic syndrome were discussed in a symposium on "Meeting the Challenges in Cardiovascular and Metabolic Diseases" held recently at the Mimosa Holiday Inn.

It was attended by 180 of the country’s top medical specialists, composed of cardiologists, endocrinologists, neurologists, nephrologists and other internists.

The lectures were given by Dr. Philip Barter, world-renowned expert on cholesterol management who is the head of the Heart Research Institute in Sydney, Australia; Dr. Ricardo Fernando, founding president of the Institute for the Study of Diabetes; and Dr. Rafael Castillo, president of the Clinical Hypertension and Atherosclerosis Research on Therapies, Epidemiology and Risk-management (CHARTER).

The symposium was co-chaired by Dr. Rody Sy, president of the Asian-Pacific Society of Atherosclerosis and Vascular Diseases, and Dr. Annette Borromeo, immediate past president of the Philippine Heart Association.

Barter explained that MS is a cluster of clinical problems composed of obesity, diabetes, mild high blood pressure, a low HDL, and high blood triglycerides.

The National Cholesterol Education Program (NCEP) in the United States defined metabolic syndrome as the presence of three or more of the following criteria:

• Abdominal fat in men, 40-inch waistline or greater; high fasting blood sugar of at least 110 mg/dl; high serum triglycerides of at least 150 mg/dl; low HDL-C of less than 40 mg/dl; and blood pressure (BP) of 130/85 mmHg or higher.

The actual prevalence of the syndrome in Asia is not known at this time, but it is estimated to be significantly high due to the increasing trend of diabetes in the region and the low levels of the good type of cholesterol or high-density lipoprotein (HDL) commonly observed.

Barter recommended that affected individuals should start with lifestyle measures designed to promote weight reduction and to increase the level of physical activity.

However, Barter added that in many people, lifestyle measures are inadequate. "In these people, drug therapy is required to reduce the high risk of cardiovascular disease," he said.

The use of the fibrates class of cholesterol-regulating drugs such as fenofibrate (Lipanthyl) is recommended for MS. "The benefits of fibrates are especially large in metabolic syndrome," Barter stressed.

He explained that treatment with fibrates results in a 40-50 percent reduction in cardiovascular events or complications. It reduces the bad type of cholesterol (LDL) and triglycerides, and increases the good type of cholesterol (HDL).

Risk factors, serious complications

Fernando, a commissioner of the National Diabetes Commission, attributed the increasing prevalence of MS to the culture of "eat all you can, and drink all you can."

According to Fernando, the results are disastrous because once clinical obesity is developed, it leads to a lot of other risk factors and serious complications of metabolic syndrome which may be difficult to reverse.

"Looking at ways and means to treat endothelial dysfunction could be the key to reverse the complications of MS and other serious cardiovascular problems," Castillo said.

He explained that endothelial dysfunction or ED is a problem in the inner lining of the blood vessels in the body. "Since all the organs of the body are supplied by blood vessels, ED is involved in practically all cardiovascular problems," he added.

Sy and Borromeo noted that the predisposition of insulin resistance and its metabolic abnormalities which include hypertension, high triglycerides, decreased HDL-C, type 2 diabetes mellitus (DM) and obesity, seem to be genetically related and is a prevalent problem among Asians.

"It is an imminent cardiovascular threat in the Asian region," warned Sy. He said Asians are more prone to have high levels of low-density lipoprotein or bad cholesterol and low levels of high-density lipoprotein or good cholesterol compared to their western counterparts.

Fernando said that cardiovascular risk factors tend to occur at lower body weights among Asians. The body mass index or BMI is usually used by clinicians as a more accurate way of determining whether one is overweight or not.

According to Fernando, insulin-resistance is a basic mechanism causing the adverse effects of the metabolic syndrome. Insulin is the substance helping in the metabolism of sugar and carbohydrates ingested.

He said Asians appear to have a relatively higher fasting sugar and elevated insulin levels suggesting insulin resistance.

Increased insulin or hyperinsulinemia with resulting insulin resistance is reported to have an unfavorable effect on the cardiovascular system, specifically on the blood vessels, making them less flexible and more prone to progressive atherosclerosis.

People with metabolic syndrome are therefore at a higher risk for coronary heart disease and cardiovascular death.

Fernando challenged doctors to be models of a healthy lifestyle, since this still remains the mainstay in the treatment of MS. "Do it for your children and grandchildren’s sake, so they can learn healthy habits as they grow up," he said.

When drug therapy is needed, he agreed that fibrates are preferred since drugs like fenofibrate enhances HDL and lowers serum triglycerides. It also reduces the level of fibrinogen, which has been implicated as an emerging risk factor in cardiovascular complications.