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January 3, 2006

A University of Michigan Health Minute update on important health issues.

When three out of five is bad:

Many Americans have three of the five factors that create high heart & diabetes risk, U-M doctor says

ANN ARBOR, MI -The old saying “three out of five ain’t bad” might be true in sports. But when it comes to your heart, three out of five can definitely be bad, says a University of Michigan expert.


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More and more doctors agree that there are five basic factors that can lead to heart disease and diabetes – and that anyone with at least three of these characteristics is at especially high risk. Many Americans, even those who think they’re perfectly healthy, have at least three, says Melvyn Rubenfire, M.D., director of Preventive Cardiology at the U-M Cardiovascular Center.

Now, he and other heart experts are encouraging people to find out if they have those three to five “risk factors,” as they’re called, and to take action to reduce them. The good news is, many people can cut their risk and eliminate one or more risk factors with steps like better eating habits, more exercise and stopping smoking.

If more Americans knew their risks and did something about it now, he says, they might be able to avoid heart attacks, strokes, surgery, and lots of medications later.

The medical name for this collection of risks is metabolic syndrome, also sometimes called syndrome X. Recently, the American Heart Association published its first guideline for diagnosing and treating it. Although there’s some debate over exactly what test results a person should have to be diagnosed with metabolic syndrome, Rubenfire explains that there are five key risk factors to look at:

  • Blood pressure that’s at or above 135/95, or that’s being lowered by drugs 
  • Weight, especially if it’s concentrated around the middle rather than the hips, causing a waist measurement over 40 inches (men) or 35 inches (women)
  • Blood sugars over 100 on a test conducted in the morning before breakfast
  • Triglycerides, a kind of fat in the blood, especially if it measures over 150
  • “Good” cholesterol levels that are lower than 40 in a man or 50 in a woman

“None of these values is considered a major risk factor by itself,” Rubenfire explains. “They’re all actually normal values, but when put together, three or more of them constitute a very high risk.”

In fact, he says, these different factors seem to multiply one another, interacting in a way that makes a person more likely to have heart disease or develop diabetes in the future. People with metabolic syndrome are two to four times as likely to have a heart attack or stroke, and five times more likely to have diabetes over the long term.

Metabolic syndrome isn’t a disease, he explains, but rather a collection of warning signs that the body isn’t dealing well with the built-up effects of diet, lifestyle and inherited traits.

Blood pressure, for example, is actually a measurement of whether the walls of blood vessels have started to stiffen. Blood sugar in the morning, after a night of fasting, is a measure of how well the body is processing the carbohydrates that come in through food. If it’s high, it signals a condition called “insulin resistance” that means the body is losing its ability to absorb sugars from the blood.

Meanwhile, the triglyceride and “good” (HDL) cholesterol measurements show how well the body is coping with the amount of fat that comes in from food, and how likely it is that the fat is building up on the walls of blood vessels. And being overweight, especially around the middle of the body, puts a strain on the heart and blood vessels -- while also signaling that the body is getting more calories than it can burn and is storing them away as body fat.

People who have already been diagnosed with diabetes, or had a heart-related problem such as chest pain, can also have metabolic syndrome, and the risk of further problems that comes with it.

In his daily practice, Rubenfire treats many patients who have suffered heart attacks or chest pains and need drugs, surgery and rehabilitation to reduce their risk of further problems. About 60 percent of heart attack and stroke patients had metabolic syndrome, he says -- but most didn’t know it.

That’s why he and his colleagues have started a program for people who have three or more metabolic syndrome risk factors. Called MetFit, it guides participants through three months of exercise, diet counseling, medical testing, stress-reduction, and education.

But even without a special program, Rubenfire says, people who have metabolic syndrome can take action on their own, or with their doctor’s help. First things first, get tested, especially if you’re overweight or there’s a history of diabetes or heart disease in your family. Then, start making changes that are specific to your risk factors.

“The individual risk factors need to be treated no matter what, and they respond very, very well to lifestyle change,” he says. “Very often, it’s a lifestyle of physical inactivity, eating the wrong foods and too much of them, and genetic factors that contribute to this syndrome. The important thing is to change your lifestyle, so you can make a big impact on your risk factors and markedly reduce your risk of diabetes and heart disease.”

The specific steps to take are the same ones doctors have been telling heart and diabetes patients to do for years:

Exercise: Whether it’s walking, jogging, sports, aerobic dance or swimming, just moving more than you already do can make a big difference. If you’re not active now, find activities that you like and find time to do them. Exercise can help you burn calories, whittle away your body fat, and reduce your blood pressure, “bad” cholesterol and blood sugar.

Eat smarter: Choose foods that have “good” fats, reduce or eliminate foods that have cholesterol and sugar, and increase the amounts of fruits and vegetables and whole grains you eat. What you eat, and how much, can make a big difference in all of the metabolic syndrome risk factors.

Stop smoking: Smoking stiffens your blood vessel walls, causing your blood pressure to go up. It also aggravates the inflammation in your blood vessels that can combine with high cholesterol to create clots and plaque that can lead to chest pain, heart attacks and stroke.

Deal with stress: Stress can aggravate your blood pressure and get in the way of health. Identify the sources of stress in your life and take steps to reduce them or address them in a new way.

While you’re doing all of this for yourself, pay attention to the health of your children or grandchildren, too. Since many of the metabolic syndrome factors have links to our genes, they might have inherited risks from you and other members of your family.

One in 20 American kids has several metabolic syndrome risks factors already, Rubenfire says, but neither they nor their parents realize it. And with more and more kids, teens and young adults now weighing too much, eating too much and exercising too little, we’re setting our country up for an epidemic of metabolic syndrome and the heart disease and diabetes that will come from it. Rubenfire predicts that half of all Americans might have three of the five metabolic syndrome risk factors within a decade if the current trends aren’t reversed.

That change will have to start with individuals who decide to get tested, and doctors who make sure to test, he says. The sooner a person realizes that they’re at risk of heart disease and diabetes because of the “three out of five” risk factors, the sooner he or she can do something about it. “It’s a preventable problem,” he concludes. “We can prevent diabetes, we can prevent heart disease, and it doesn’t require medication. It requires only a change in your willingness to exercise and diet.”

About metabolic syndrome:

  • Metabolic syndrome isn’t a disease, but rather a condition where a person has at least three of five “risk factors” that increase their chance of developing heart disease and diabetes.
  • As many as one in five Americans may have three of the five metabolic syndrome risk factors, and most don’t know it. People who are overweight, especially those who carry that extra weight in their midsections, are most likely to have metabolic syndrome.
  • The risk factors involve blood pressure, weight, blood sugar, blood triglycerides, and blood levels of HDL or “good” cholesterol. While there is some debate over the exact levels or measurements where risk begins, the general idea is that high-normal, and higher-than-normal, levels, are a concern – except in HDL cholesterol where higher is better.

For information on metabolic syndrome, the MetFit Program, and other heart-related treatment at the U-M Cardiovascular Center, call 888-287-1082.

Find out more on the web at:
U-M Health Topics A-Z: Metabolic Syndrome

U-M Cardiovascular Center: MetFit Program

U-M Cardiovascular Center: Heart prevention information

American Heart Association – Metabolic Syndrom

Written by Kara Gavin


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