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Chapter 26: The Metabolic Syndrome

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Which of the following is not considered a component of the metabolic syndrome (MetS)?

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A. Central adiposity

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B. Insulin resistance

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C. High serum low-density lipoprotein (LDL) cholesterol

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D. High serum triglycerides

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E. Hypertension

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The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 26) The metabolic syndrome is a theoretical construct from the clustering of interrelated processes to better represent complex pathophysiology for actionable and effective clinical decision making. Specifically, the rationale and practical utility of MetS is to facilitate early diagnosis, risk stratification, and management of cardiometabolic risk factors. This topic is relevant, but it also remains controversial because many aspects remain unproven. Nevertheless, the core principle is that the value of MetS is related to the impact of residual risk (total risk minus the aggregate of known specific risk factors) on cardiovascular disease (CVD). Currently, the diagnosis of MetS is based on a set of commonly measured metabolic markers: abdominal girth (option A), hyperglycemia (option B), hypertriglyceridemia (option D), hypertension (option E), and low high-density lipoprotein (HDL) levels. However, debate still exists over the relative weighting of each of these measures in a predictive model for morbidity and mortality risk. Low-density lipoprotein levels are not among the diagnostic criteria (option C).

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Which of the following statements concerning the MetS is not true?

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A. Insulin resistance and central adiposity are required for a diagnosis of MetS

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B. Three of the five criteria are always required for a diagnosis of MetS

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C. Between 20% and 35% of the worldwide adult population have MetS

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D. Atherosclerotic risk rises in association with the severity of MetS

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E. Residual risk describes the remaining increased risk for atherosclerosis after the treatment of a specific risk factor

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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 26) While the diagnostic criteria for MetS vary by organization, either insulin resistance or central adiposity (but not both) are generally required for a diagnosis of MetS (option A). The exception is the criteria of the American Heart Association/National Heart, Lung, and Blood Institute, which do not make a specific requirement for either. By all definitions, three of five criteria (abdominal girth, hyperglycemia, hypertriglyceridemia, hypertension, and low HDL levels) are required for a diagnosis of MetS (option B). Depending on the specific criteria used, approximately 20% to 35% of various reported worldwide adult populations have MetS (option C). Overall, atherosclerotic risk rises in association ...

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