Cardiometabolic syndrome (CMS) is a group of metabolic dysfunctions mainly identified by insulin resistance, high blood sugars, high cholesterol, high blood pressure, and central adiposity or belly fat. CMS is now recognized as a disease entity by the World Health Organization and the American Society of Endocrinology.

Cardiometabolic Syndrome combines cardiovascular disease and metabolic syndromes. Cardiovascular disease can refer to a number of conditions: such as Heart Attacks, Stroke, Heart Failure, arrhythmias, heart valve problems. Metabolic syndrome refers to a person’s belly fat, elevated triglycerides or elevated blood pressure, low HDL cholesterol or blood sugar abnormalities. Can also refer to diseases like PCOS, diabetes and pre-diabetes.

Diagnosis:

Any 3 of the following 5:

Increased waist circumference(>35” women, >40” men)
Blood Pressure(> 130/>85 mmHg or on HTN meds)
Fasting Blood Sugar (>100 mg/dl)
Triglycerides (>150 mg/dl)
HDL Cholesterol(<50 mg/dl women,<40 mg/dl men)

Risks Associated With CMS

You are at risk if you are overweight, use tobacco, have uncontrolled high blood pressure, or have ever had abnormal blood sugars.
If you can get to age 50 without any of these risk factors, your lifetime risk of a heart attack or stroke for men is about 5%, and for women it’s 8%.
But, if you have two or more of these risk factors at age 50—
- For men, your chances of dying of a heart attack or stroke are almost 14 times higher than someone who has no risk factors. So for men, behavior makes a huge difference.
- For women, your risk is about 8 times higher than a woman who makes it to age 50 without any of the risk factors, which is still a lot.

Even just one of these risk factors increases your risk:
- Men with one risk factor are 10 times as likely to die of a heart attack or stroke.
- Women with one risk factor are about 5 times as likely as someone with none to die of a heart attack or stroke.
- Persons with diabetes at age 50 have the greatest risk of dying of a heart attack.
- Smoking alone doubles your risk of dying of a heart attack, although smokers are more likely to die of cancers before they have a heart attack or stroke.

Pathophysiology

Increased waist/belly fat can lead to increased inflammation and increased clotting risks. Having both a fatty liver and a high waist fat are associated with CMS, but the association is stronger for belly fat. It has been demonstrated that waist circumference is a more sensitive parameter than body mass index for prediction of cardiac risk.

Various studies have shown damage to the mitochondria and their oxidative mechanisms are associated with development and progression of metabolic syndrome. It is also reported that defective oxidative metabolism seems to be involved in visceral fat gain and the development of insulin resistance. Excess secretion of free fatty acids from fat tissue is also associated with insulin resistance through a reduction in glucose (sugar) transport into the muscles.

Among all CMS risk factors, the relation between insulin resistance and high blood pressure is well established. First, insulin is a vasodilator which means it decreases blood pressure. Secondly, it also decreases the reabsorption of salt by the kidneys leading to lower blood pressure. Having high insulin production due to having insulin resistance leads to high blood pressure.

Here are the diseases that are associated with insulin resistance or cardiometabolic syndrome: (IFM Slide)

Treatment Challenges

There is ongoing research on controlling each individual component of this disease to reduce cardiovascular morbidity and mortality. The current approach to the treatment of CMS includes aggressive control of the classical risk factors, including dyslipidemia, hypertension, diabetes, and smoking. However, in functional medicine we want to address the cause, which include the cause of high plasma insulin, belly fat, Clot promoting factors and proinflammatory cytokines.

The primary goal of treatment is to reduce inflammation and find the cause of insulin resistance.

Exercise and Nutrition are medicine

Moderate physical activity, weight reduction, rigorous blood pressure control, correction of dyslipidemia, and glycemic control, have proven beneficial in reversing cardiovascular risk.

Exercise experts agree that par-ticipating in a minimum of 30 minutes of moderate-intensity physical activity, such as fast walking, on a daily basis will reduce the rate or intensity of CMS. Regular exercise in patients with CMS has been shown to reduce the risks associated with death.

Diet and regular exercise have shown reduction in the development of diabetes over diabetes medications. Treatment should also focus on reducing LDL cholesterol and, once that is achieved, on bringing triglyceride levels to <150 mg/dL.

Both good nutrition and moderate exercise can bring down inflammation and improve insulin resistance.

Weight-Loss

Conventional medicine recommends weight-loss surgery to manage type 2 diabetes in persons who are severely obese. However, because weight loss surgery is associated with nutrient deficiencies, in functional medicine we recommend changes in nutrition or diet over surgery.

By eating a phytonutrient rich diet, no ultra-processed foods, a diet that will decrease inflammation and induce weight loss. If you then add exercise, which is also anti-inflammatory, to aid in weight loss.

Costs of CMS

A meta-analysis of 383,420 individuals with one or more components of CMS (hypertension, diabetes, lipid abnormalities, and adiposity) revealed that the adjusted total annual healthcare cost per individual patient with one component of CMS was $5,564 while the cost of care for those with four components came to $12,287.

In the U.S., patients with CMS risk factors were 40% to 45% less likely to be employed, and they missed 179% more workdays, creating $18.7 billion in lost productivity in 2007. In 2002 dollars, obesity and smoking each had a national medically related price tag in excess of $90 billion.

In 2014, national medical expenditures attributable to cardiometabolic risk factor clusters (CMRFC) in the U.S. totaled $80 billion, of which $27 billion was spent on prescription drugs. On average we are getting sicker, weigh more, are less productive and more dissabled. We also have an average of four to five prescriptions if age greater than 60, and one prescription if age less than 60.

A List of things you can change to optimize your metabolism.

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Conclusion

With the amount of money spent on health, the number of prescriptions; you think we would be getting better but the truth is we are worse off than 20-30 years ago. Current treatment of chronic disease has failed, this is where functional medicine comes in. A better way to treat chronic disease and treat patients as humans and not just disease states.

(Cardio)Metabolic Syndrome