Cardio-Metabolic Syndrome

February 8, 2017

Cardio-metabolic syndrome (CMS) is characterized by a group of cardiovascular and metabolic risk factors. ​Cardio-metabolic syndrome is a combination or cluster of risk factors that, together, increase the risk of developing cardiovascular disease and diabetes. The risk factors that make up this cluster include –

  • Central obesity (waist circumference greater than the desired target level)
  • High triglycerides
  • High blood pressure
  • High fasting blood glucose
  • Low HDL (good cholesterol)
  • High LDL (lousy cholesterol)

If an individual has at least three of these conditions, the patient likely has metabolic syndrome, and the risk of developing cardiovascular disease or diabetes is greatly increased. That means an increased risk of complications, including loss of eyesight and kidney failure from diabetes, and heart attack and stroke from cardiovascular disease. This means that it is extremely important for people to work with their healthcare professional team to make changes to their lifestyle and possibly their medical care.

A wide range of traditional and newly recognized risk factors contribute to cardiometabolic disease, and it is important to review all of them during a patient examination.

Traditional cardio-metabolic risk factors –

  • Age
  • Sex
  • Family history
  • Hypertension
  • Dysglycemia
  • Dyslipidemia
  • Smoking

Other cardio-metabolic risk factors –

  • Abdominal obesity (measured by waist circumference)
  • Insulin resistance
  • Inflammation (measured by high-sensitivity C-reactive protein levels)
  • Lack of consumption of fruits and vegetables
  • Sedentary lifestyle
  • Psychosocial stress


Genetics – Some people are genetically more inclined to develop insulin resistance, which can lead to metabolic syndrome. People from Asian, African-Caribbean and Hispanic (Latin-American) backgrounds have a higher risk of developing metabolic syndrome. People with a family history of type 2 diabetes, high blood pressure and early heart disease are are also more susceptible.

Obesity/overweight – Especially if the person continues gaining weight every year and has too much belly fat (abdominal obesity).

Physical inactivity – Lack of exercise is a major contributory factor towards metabolic syndrome risk. Women are more likely to develop metabolic syndrome due to lack of exercise than men.

Diet – Some studies have linked sugary drinks with metabolic syndrome. High-fat diets can also induce insulin resistance, even after a few days.

Age – Metabolic syndrome rates are much higher among older people. Over 40% of people aged 60+ years have metabolic syndrome, compared to less than 10% among twenty-year-olds. However, metabolic syndrome can occur at any age.

Sleep apnea – People with sleep apnea are more likely to suffer from insulin resistance, which in turn raises the risk of metabolic syndrome.

Hormonal imbalance – People with hormonal problems may have a higher risk of developing metabolic syndrome. An example is PCOS (polycystic ovary syndrome).


  • Sources of inflammation in the body
  • Existing nutrient deficiencies
  • The production of free radicals inside your body


The symptoms include –

  • Obesity – especially if you have an apple shape, with too much fat built up around the waist, known as “central obesity” or “abdominal obesity”. A man’s waist will be at least 102 centimeters (40 inches) and a woman’s 89 centimeters (35 inches). The waist circumferences can vary, according to the height and frame of the individual.
  • Hypertension (high blood pressure) – blood pressure of at least 130/85mmhg. Some countries, such as the UK place the threshold at 140/90mmHg .
  • High blood sugar – a fasting blood glucose of at least 5.6 mmol/L (100 mg/dL). The person’s body is unable to control blood sugar levels, also known as insulin resistance.
  • Abnormal blood cholesterol – low levels of HDL, also known as high-density lipoprotein or “good cholesterol”, less than 40mg/dL (1.04mmol/L)
  • High blood triglycerides – triglycerides are a form of circulating fats. Levels of at least 150mg/dL or 1.7mmol/L.

People with metabolic syndrome also have a higher risk of deep vein thrombosis, and tend to develop inflammation.


Lifestyle Modification – Lifestyle modification is the primary management strategy for cardiometabolic syndrome. This can be challenging to implement in a primary care practice because it requires simultaneous counseling on physical activity, diet, and smoking cessation with regular follow-up over a long period of time. Clinical guidelines recommend that lifestyle modifications be continued for 3 to 6 months before considering pharmacotherapy unless patients are at high risk. The importance of continuous, lifelong behavior change should be communicated to patients, even if they receive pharmacotherapy.

  • Eat better
  • Get active (exercise)
  • Lose weight
  • Take medications
  • Limit alcohol intake
  • Stop smoking

Nutritional Supplements

Protein and bioactive peptides – Milk protein, especially whey protein, has been shown to improve body composition and to have a positive impact on muscle protein synthesis. It has been demonstrated that whey protein helps in controlling blood glucose levels.

Vitamin D – Several epidemiological studies have demonstrated that adequate vitamin D intake and status may be protective against metabolic syndrome. Many mechanisms have been proposed to explain how vitamin D may modulate cardiometabolic health. These include the reduction of dyslipidemia through the maintenance of calcium homeostasis, the stimulation of insulin production and release, and the regulation of the renin-angiotensin-aldosterone system, which helps in blood pressure control.

Conjugated linoleic acid (CLA) and milk fat – Milk fat appears to improve the ratio of HDL-cholesterol to total cholesterol. Saturated fatty acids present in milk fat also have a favourable impact on triglyceride levels.

Calcium, potassium and magnesium – Evidence suggests that calcium may improve the blood lipid profile through the potential mediation of fecal fat excretion.


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