Identification and Management of Metabolic Syndrome: The Role of the APN

Douglas H. Sutton, EdD, MSN; Deborah A. Raines, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(2) 

In This Article

Definition and Criteria

According to the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI), the interrelated risk factors for metabolic syndrome include[12,13]:

  • Insulin resistance;

  • Atherogenic dyslipidemia;

  • Hypertension;

  • Obesity (particularly central or abdominal obesity); and

  • Defects in coagulation, inflammation, and fibrinolysis.

The International Diabetes Federation (IDF) has also defined metabolic syndrome, and although similarities can be found in regard to specific values for most risk factors, the IDF has replaced "central or abdominal obesity" with the more narrowly defined "increased waist circumference.[14]" The joint AHA/NHLBI scientific statement, published September 12, 2005, identifies the dominant underlying risk factors as abdominal obesity and insulin resistance.[2]

The panel of experts who developed the statement reviewed, affirmed, and reinforced that individuals who experience abnormal levels of 3 of 5 criteria should be considered as having metabolic syndrome. The current diagnostic criteria, which are based on the AHA/NHLBI scientific statement, are as follows[2]:

  • Increased waist circumference (abdominal obesity): men ≥ 40 in (102 cm), women ≥ 35 in (88 cm);

  • Elevated triglycerides (dyslipidemia): 150 mg/dL or higher;

  • Reduced high-density lipoprotein cholesterol (HDL-C) (dyslipidemia): men < 40 mg/dL, women < 50 mg/dL;

  • Elevated blood pressure (BP): 130/85 mm Hg or higher; and

  • Elevated fasting glucose (insulin resistance): 100 mg/dL or higher.

According to the AHA/NHLBI scientific statement, the most widely recognized of the metabolic risk factors include atherogenic dyslipidemia, elevated plasma glucose, and elevated BP.[2] The term "atherogenic dyslipidemia" refers to the grouping of lipoprotein abnormalities that include:

  • Elevated serum triglyceride levels;

  • Increased low-density lipoprotein cholesterol (LDL-C); and

  • Reduced HDL-C.

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