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

2. 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,

3. 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 and 2002 (The Medical Expenditure Panel Survey).

4. 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.

5. 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.

6. 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.

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

8. METHODOLOGY EXCLUSION CRITERIA
CAD or MI on problem list
ICD Code &
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

9. 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.

10. 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.

11. 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)

12. METHODOLOGY

13. RESULTS Variables N= 46 % SEX Male 15 33% Female 31 67% RACE Hispanic37
80%
Non-Hispanic
AVERAGE AGE 9
47.5
20%

14. RESULTS

15. 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

16. RESULTS

17. 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.

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

19. 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

20. 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.

21. REFERENCES
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Fruchart, J., James, P., & Smith, S. (2009). Harmonizing metabolic syndrome. A joint
interim statement of the Diabetes Federation Task Force on Epidemiology and Prevention
; National Heart, Lung, and Blood Institute; American Heart Association; World Heart
Federation; International Atherosclerosis Society; and International Association for the
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22. 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
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:

28. Summer time!!!!!!