METABOLIC SYNDROME SCREENING IN PRIMARY CARE CAROLYN U. ROJO FAIRFIELD UNIVERSITY

BACKGROUND MetS (Metabolic Syndrome) is a global epidemic, characterized by constellation of risk factors such as hyperinsulinaemia, low glucose tolerance, dyslipidemia, hypertension, and central obesity. MetS is a precursor to the development of cardiovascular diseases (CVDs) and Type II DM. Patients with MetS are at twice the risk of developing CVD over the next 5 to 10 years,

BACKGROUND CONT. and a five fold increase for type II diabetes mellitus. Approximately 47 million Americans have MetS. A total of 80 billion dollars are attributed to cardio-metabolic risk factors for the years 2000 and 2002 (The Medical Expenditure Panel Survey).

BACKGROUND CONT. Identifying and managing at risk population in primary care may reduce incidence of CVDs and type II diabetes. Screening could be a dilemma due to lack of standardized criteria for clinical diagnosis. Recently, a common criteria was established by several major organizations to diagnose MetS. Interventions should focus on preventing all components of metabolic syndrome.

OBJECTIVES Identify patients who have No-Mets, At-Risk-for- Mets, and MetS. Develop a screening tool that will help identify patients with Metabolic Syndrome. Create a registry of patients with Metabolic Syndrome for target intervention and close monitoring.

METHODOLOGY Random chart review of patients who presented to the clinic from January 2010 to June 2010. Data collection proceeded after having met the inclusion and exclusion criteria. Three patient identifiers, age, blood pressure, fasting blood glucose, HDL-C, triglyceride level, body mass index, sex, ethnicity, co- morbidity, and medications were recorded.

METHODOLOGY Inclusion Criteria Male or Female Ages >18 & <75 years old Any ethnic background Not in exclusion criteria

METHODOLOGY EXCLUSION CRITERIA CAD or MI on problem list ICD Code 410-414 & 429.2 History of angioplasty or PTCA History of abnormal troponin DM on problem list HgA1C> 7% Diabetes specific medications ICD Code 250.0 Ages <18 & >76 years old

METHODOLOGY Patients with clustering risk factors were assessed using the criteria set by the Joint Interim Statement for Metabolic Syndrome, such as: Elevated waist circumference. BMI > 30 was substituted in the absence of waist circumference measurement. Triglyceride level > 150 mg/dl or a drug treatment for elevated triglyceride level.

METHODOLOGY CONT. Reduced HDL-C (<40mg/dl in males & <50 in females or a drug treatment for reduced HDL). Fasting blood glucose > 100 mg/dl. Elevated blood pressure > 130 and /or diastolic > 85 mmHg.

METHODOLOGY Patients were then classified into three categories: CONT. Patients were then classified into three categories: No – MetS (0 Risk Factors) At-risk-for-MetS (1-2 Risk Factors) MetS ( 3 or more Risk Factors)

METHODOLOGY

RESULTS Variables N= 46 % SEX Male 15 33% Female 31 67% RACE Hispanic 37 80% Non-Hispanic AVERAGE AGE 9 47.5 20%

RESULTS

RESULTS Risk Factor 1 - Triglyceride > 150 Risk Factor 2 - HDL-C < 40 (Male), <50 (Female) Risk Factor 3 - Fasting Blood Sugar >100 mg/dl Risk Factor 4 - Blood Pressure > 130/85 mmHg Risk Factor 5 – BMI > 30 Male/ Female

RESULTS

CONCLUSION MetS was not diagnosed in any of the patients. No waist circumference was ever recorded in any patients. MetS incidence is more in females than in males. Among the risk factors for MetS, elevated Body Mass Index has the highest incidence in the population. More than half of patients are at risk for MetS.

RECOMMENDATIONS The ABCDE approach to Metabolic Syndrome (Tota et. al) A -Assessment of MetS A- Aspirin 75-81 mg in the absence of contraindication. B – Blood pressure control. Aim for 125-130/80 mmHg ACEIs/ARBs first line Calcium channel blockers second line BBs and Thiazides third line

RECOMMENDATIONS CONT. C – Cholesterol First target: LDL Second target: non-HDL Third target: HDL Fourth target: CRP D –Diabetes prevention Intensive lifestyle modification Weight loss, reduction in salt intake Mediterranean diet

RECOMMENDATIONS CONT. Dietary supplementation of polyunsaturated uric acids. Metformin as second line in delaying NIDDM onset. TZDs, AGIs, and incretin mimetics as third line. E- Exercise Daily vigorous activities. Recommend use of pedometer with goal >10,000 steps/day.

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REFERENCES Hivert, M.F., Grant, R., Shrader, P., & Meigs, J. (2009). Identifying primary care patients at riskfor future diabetes and cardiovascular disease using electronic health records. RetrievedJuly 8, 2010 from http://www.biomedcentral.com/1472-6963/9/170 Rajesh, T., Defilippis,A., Blumenthal,R., & Blaha, M. (2010). A practical approach to the Metabolic syndrome: Review of current concepts and management. Current Opinion in Cardiology, 25:000-000.  

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