Metabolic Syndrome is  a disease which includes all risk factors increasing possibility of heart attack.  The most important component of these diseases collected under Metabolic Syndrome title is fatness.  Fatness which is called as obesity in medicine means over weight which will cause fatal diseases including heart attack if not prevented.  Therefore, we define obesity as fatness which should be treated.

	Metabolic Syndrome and Heart Attack

Insulin resistance developed on basis of obesity and Type 2 Diabetes are other important factors appeared because of obesity of metabolic syndrome.  Obesity, insulin resistance and Type 2 Diabetes lead up to many diseases.

One fourth of adults in the world have metabolic syndrome.  Premature deaths are seen two times more in individuals with metabolic syndrome and paralyses are seen four times more.

3.2 million people die because of diabetes-induced diseases directly in the world.  Especially in regions where diabetes is more such as Middle East, one of each four individuals dies because of diabetes.  80% of these deaths are diabetes-induced heart diseases and heart attacks.   Type 2 Diabetes has become an epidemics in the world.  Cardiovascular diseases has become to be the second epidemics because of extensity of Type 2 Diabetes.  The 5^th most common cause of death in the world is Type 2 Diabetes and associated heart diseases.

How Do I Understand That I have Metabolic Syndrome?

Metabolic syndrome definition includes many different disorders or diseases.  Even though an individual has 3 or 4 of these, it is called as metabolic syndrome.  However, more diseases together means increased risk for heart attack and paralysis.

If you have 3 of the following disorders, you have metabolic syndrome:

• Type 2 Diabetes (Fasting Blood Glucose > 126 mg/dl)
• Central Obesity (fatness with excessive intraabdominal and waist lipoidosis) or Waist Circumference  ≥ 102 cm for Men and ≥ 88 cm for women
• Hypertension (Blood pressure over 120/80 mmHg)
• Triglyceride ≥ 150 mg/d lor HDL ≤ 40 mg/dl
• Microalbumin excretion in urine ≥ 20 μg/minute

These findings are main lines determined for diagnosis of metabolic syndrome.  However, another findings are added sometimes additionally. For example, you do not have to have a diagnosed Type 2 Diabetes.  Presence of Insulin Resistance or spoilt fasting blood glucose individually are important for your metabolic risk syndrome.   Observation of any of these with obesity with intraabdominal fat collection requires close monitoring in terms of metabolic syndrome.

Importance of obesity and Type 2 Diabetes should be emphasized while defining Metabolic Syndrome.  We may consider Metabolic Syndrome as total of all accompanying problems created by obesity-induced Type 2 Diabetes. However, Metabolic Syndrome contains problems that may cause obesity as well.  Complex interpenetration of these diseases complexly makes difficult to differentiate the source and outcome.

Instead of counting causes for Metabolic Syndrome individually, it is more accurate to define all problems increasing risk of heart attack as a part of metabolic syndrome.

What are Conditions Associated With Metabolic Syndrome?

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	Metabolic Syndrome Associated Diseases

• Obesity
• Insulin Resistance
• Spoilt Glucose Tolerance
• Type 2 Diabetes
• Triglyceride Elevation
• Bad Cholesterol Elevation (LDL)
• Good Cholesterol Reduction (HDL)
• Hypertension
• Vascular Obstruction and Heart attack
• Obstruction or bleeding in brain vessels or Paralysis
• Onset of Kidney Failure (albumin leak in the urine)
• Hepatic lipoidosis and cirrhosis development due to excessive lipoidosis in the liver (Non-Alcohol Dependent Hepatic Lipoidosis causes liver damage progressing to cirrhosis)
• Permanent Inflammatory Condition (Chronic Inflammation)
• Cellular disorder on the vessel wall and Coagulation tendency
• Sleep-Apnea Syndrome (long interruption of breath during sleep)
• Polycystic Ovary Syndrome (a disease progressing with obesity and excessive hairing due to multiple ovarian cysts)
• Demence on elder age

Treatment of Metabolic Syndrome

Treatment of metabolic syndrome is actually provided by control of obesity treatment and diabetes.  There is not any specific medication for treatment of Metabolic Syndrome.  First, to change lifestyle and diet order is important.  Regular exercise and to quit smoking are also very important.  You may apply different exercises according to your age and severity of diseases that you have.  Regular walking which is the simplest and easiest are important in control of both hypertension and cholesterol elevation.  Blood glucose regulation is easier with exercise and correct nutrition.

Steps suggested may be ordered as follows:

Weight Loss: Exercise and healthy diet are key for healthy weight loss. Even a decrease by 10% on your body weight helps to reduce complaints.  For example, if you are 100 kg, 10 kg weight loss will help.  However, the important is not to loose weight, but to keep this weight.  It is known that diet and exercise fail to preserve weight loss solely.  If body mass index is 30 kg/m2 and over and your metabolic syndrome can not be controlled with drugs and diet, consult for metabolic surgery before it is too late.  Metabolic surgery is the most efficient treatment of obesity-dependent metabolic syndrome.

Physical Activity and Exercise: Regular exercise reduced insulin resistance, normalizes blood fats and provides to preserve weight loss.  Regular walking decreases risk for heart attack.  To take 1000 steps daily prevents vascular obstruction.

Decrease of Insulin Resistance: Obesity and insulin resistance are two conditions that should be considered together.  Drug therapy may be necessary for control of these two conditions as well as exercise and diet.  Especially metformin group (glucophage i.e.) diabetes drugs decrease insulin resistance and they may be used without need of weight gain.  Effects of these drugs decrease after first year.  Complete elimination of insulin resistance should be the main target of the treatment.  There is not any diet, exercise and drug therapy (even applied together) are not as effective as metabolic surgery to control insulin resistance permanently.  Obtain information about metabolic surgery methods before your insulin resistance and obesity turn into diabetes.  The absolute solution of your problems is possible with metabolic surgery.

Correction of Blood Fat Disorder: Bad cholesterol (LDL) and Triglyceride elevation and decrease of good cholesterol (HDL) are blood fat disorders detected in metabolic syndrome.   To correct this, liquid vegetable oil use is recommended instead of butters. Animal originated fats cause cardiovascular obstruction easily.  Regular exercise also contribute to regulate blood fats as well.  Achievement rate is higher when life style changes and exercise are maintained regularly.  However, it is went to the drawing board when exercise and diet program are left.  Strength of metabolic surgery on efficient control of blood fats is so high that it can not be compared with any drug and prevention. Earlier application of metabolic surgery at initiation of these disorders prevents possible problems more.

Treatment of Hypertension: Many drugs exist on classical treatment of hypertension.  However, strict salt restriction and exercise are important to provide a healthy vascular wall.  In addition, many different drugs will be started by your physician according to the needs.  The important point on treatment of hypertension is to know that you should not discontinue on drugs when your blood pressure problem is corrected by drug treatment.  Drugs which are discontinued without control may have another side effects and your hypertension problem reoccurs.  Blood pressure regresses to normal levels in eight of ten patients who had ileal interposition because of metabolic syndrome without any drugs.  Multiple drug therapy is reduced to single drug in remaining two patients.

Anticoagulant Therapy: Tendency to coagulation increases due to liver damage in Metabolic Syndrome.  Furthermore, metabolic syndrome is a chronic inflammatory process.  An indicator for inflammatory process called CRP is elevated in patients.  It has been shown that CRP elevation increases risk of heart attack and stroke very much.  It is recommended to take a single dose of 100 to 300 mg aspirin if you have metabolic syndrome.  Low dose aspirin both decreases CRP level and prevents platelets to be accumulated on the vascular wall.

	Detection of Blood Glucose

Type 2 Diabetes start insidiously.  It starts to damage your organs years before diagnosis when insulin resistance just starts.  Type 2 Diabetes firstly and mostly damages in very small blood vessels.  This condition is called microangiopathy.  Microangopathy weaken walls of small vessels.  It causes adherence of fats on vascular walls.  These fat layers which becomes thicker gradually narrows the inside of vessel.  This reduces the quantity of flowing blood into the vessels.

We may compare this condition as calcified and obstructed water pipes.  Fat particles circulating in your vessels are denser and smaller than those in normal people.  Insulin looses its effect on the liver in fat patients.  This is caused by insulin resistance of the liver.  When control of insulin hormone over insulin, liver makes fat particles secreted smaller and harder.  This small and dense fat particles adhere onto the vascular walls easier than fat particles in normal people.  Just like obstruction caused by calcified water in water pipes.

First, eye vessels are affected from this microangiopathy.  There are many of these small vessels on the layer called RETINA which is behind the eye.  Small vessels on this layer become weak and inside of vessels is obstructed with fat. Circulation of retina layer spoils.  You start to have a blurry vision first.  Then bleeding occurs from these vessels and the layer is completely covered by coagulated blood.  Blindness develops slowly and completely.  This condition is called diabetic retinopathy.  Visual disorders due to diabetes has already started years before diabetes is diagnosed.

These vascular problems affect kidney vessels.  Atherosclerosis occurs in kidney vessels.  This prevents urine production of kidney.  Because blood coming to the kidney decreases.  Kidney produces less urine and swelling occurs in the body.  This is called edema.  Furthermore, intravascular pressure increases because excessive part of blood can not be excreted by urine.  Blood pressure increases.  This is called hypertension.  Kidney fails completely after a while.  This condition is called kidney failure.  Patients whose kidney has failed can survive through machines called Dialysis to clear the blood from toxic and hazardous substances.  They are required to be connected for at least 3 to 4 days per week and everyday in some cases.

More than half of all patients who had hemodialysis treatment experience kidney failure because of diabetes.

Six of each dialysis patients need dialysis treatment because of diabetes.  The only treatment of these patients is kidney transplantation.  This organ transplantation procedure may be performed from an alive donor.  In general, intact kidneys of a dead person may be taken and transplanted to dialysis patient.

Metabolic Syndrome is a disease group which appears on diabetes basis and includes all diseases increasing risk of heart attack.  Diagnosis and treatment of individuals with metabolic syndrome is very important to prevent heart attacks and deaths.