A Different Heart Disease Risk

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SOON, METABOLIC SYNDROME will overtake cigarette smoking as the number one risk factor for heart disease in the US, reports Darwin Deen, MD, of the Albert Einstein College of Medicine in New York. Men's rate are higher in middle age, but once women reach menopause, their prevalence rates catch up.

Just what is metabolic syndrome? It's a cluster of particular symptoms. Often, heart disease risk is assessed in terms of a person's "bad" LDL-cholesterol. But these symptoms include five factors other than a high LDL level. If you have at least three of them, you have metabolic syndrome and must take certain precautions to lower your chances of having a heart attack or experiencing other life-threatening cardiac events.

abdominal/central obesity (waist circumference greater than 35 inches in women, 40 inches in men)
High triglycerides (at least 150 milligrams per deciliter of blood)
Low "good" HDL-cholesterol (less than 40 milligrams per deciliter of blood for men, 50 for women)
High blood pressure (at least 135/85)
High fasting glucose, or blood sugar, which is a diabetes precursor (at least 110 milligrams per deciliter of blood)
Treating metabolic syndrome
Attending to metabolic syndrome and thereby reducing heart disease risk involves two of the same recommendations for bringing down LDL-cholesterol and living a healthful lifestyle in general: lose excess weight, if necessary, and increase physical activity. Losing weight, particularly in conjunction with exercising more, will raise HDL-cholesterol and lower fasting blood sugar and blood pressure. A diet with plenty of vegetables and fruits as well as low in salt will also help lower blood pressure.

The one recommendation that's different from the usual advice is to avoid a very low-fat diet with, say, less than 20 percent of calories as fat. Eating so little fat inevitably bumps up carbohydrate consumption, and in someone with metabolic syndrome, too many carbohydrates can exacerbate the condition by causing both triglycerides and blood glucose to rise.

We're not talking about a dramatic shift in carbohydrates. For instance, normally, up to 55 or 60 percent of calories as carbohydrates is fine. But if you have metabolic syndrome, more on the order of 45 percent of calories is appropriate (which still means that more of your calories should be coming from carbohydrates than from protein or fat, which combined would add up to roughly 55 percent of calories).

For most people, the shift means leaving in healthful high-carb foods like vegetables, fruits, whole grains, and beans and reducing carbohydrate intake from refined grains like most pastas and breads as well as sweets like cake and ice cream. If some calories need to be added back in (which is rarely the case since most people need to lose weight rather than maintain it), they should come from very small amounts of healthful high-fat foods: a little sliced avocado or a scant handful of nuts sprinkled onto your salad; a tablespoon of peanut butter; or perhaps an extra couple of teaspoons of oil in a stir-fry.

In some cases, medications will be prescribed to augment the lifestyle efforts. But for those who achieve and maintain a reasonable weight loss and continue to exercise, the issue could potentially resolve itself, and carbohydrates might no longer be a concern.

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