Cardiac Dysmetabolic Syndrome or Syndrome X

Cardiac Dysmetabolic Syndrome (CDMS) represents a number of reversible abnormalities in the utilization of fats and carbohydrates. If not managed in time, these abnormalities can cause diabetes, high blood pressure and heart attack.  These abnormalities are lifestyle induced in majority of the cases; hence they are reversible with the improvement and change in lifestyle.

Any of the following parameters is observed for identifying the Dysmetabolic syndrome :

• Waist circumference more than 40” men and 35” in women.
• Fasting blood sugar more than 110mg per cent.
• Fasting triglyceride levels than 40 percent in men and 50 percent in women.
• Blood pressure more than 130/85 mm hg.

If not managed in time, these abnormalities progress to diabetes, high blood and heart attack.

Some facts the dangers of CMDS

• It occurs commonly in Indian population. Around 10 percent of the normal population is estimated to have this metabolic disorder. 60 to 70 percent of heart  patients are known to have these abnormalities.
• It makes  Indians four times more  susceptible  to heart  attacks  than Europeans, Americans, Japanese and Chinese.
• It puts Indians under 40 years of age at a higher risk than  others. One if four heart related risk than others. One in four heart related patient is under the age of 42 years.
• Indian women are as much  vulnerable to this disease as men.

Significance of increased waist circumference

Increased waist size usually signifies central obesity/adiposity. Central  obesity means excessive deposition of fat on the abdomen as compared to the waist, thus producing  an apple-like appearance. It is measured by waist/hip ratio (WHR). This measurement  gives an idea  about  the amount of fat present  in the body. If the WHR is more than  0.85, then it implies  that visceral  obesity  is present and can be health hazard to that individual. Visceral obesity implies that there is excess of fat deposition  in various organs. The risks associated with central obesity are as follows:

• Insulin resistance leading to increased insulin  levels in the blood.
• Higher  levels  of blood sugar.
• High triglyceride (a type of lipid/fat) levels.
• Low DHL (good cholesterol  and high levels of LDL (bad cholesterol).
• High blood pressure and increased risks of heart attacks.
• Fifteen times greater risk of uterine cancer in females.
• Increased risk of breast cancer.
• High levels of anxiety  and depression.
• Therefore  one should  attempt  to lose the fat deposited in and around the abdomen.
• High incidence of CDMS in India  is due to the following reasons :
• Thrifty gene theory

India has a shortage of food for generations in the past. Our genes are adapted to the shortage by slowing the consumption of fats and carbohydrates-the main  sources of energy. Now, we are consuming plenty of fat and carbohydrates, especially in the urban areas. Thus the genes take a longer time to adapt. Our body’s mechanisms have not yet adapted to cope with  the increased load of fats and carbohydrates. ]

This inability to cope with increased amount of food is food is manifested  as raised blood sugar and abnormal lipid levels, which lead to heart disease.

The lifestyle changes that have contributed heavily to development of CMDS are :

• Changes in eating pattern- over consumption of fats and carbohydrates.
• Lack of exercise due to a sedentary lifestyle.
• Ever persistent  and always increasing  psychological stress.
• Heavy smoking.
• Increased consumption of alcohol.
• Stress.

Stress can be acute or chronic. The body responds to stress-whether emotional stress (e.g. perceived danger) or physical stress (e.g. extreme temperature changes or exertion)- by activating a series of changes in the body functioning  known as the flight-or-flight response, which prepares us either to face the stress or to run away from the stress. The ideal  response is to respond to challenges or difficult situations fast and efficiently and then to relax.

Smoking has only deterious effects and should be strongly discouraged. Cigarette smoking represents an important risk factor for cardiovascular  disease and certain micro vascular complications like eye kidney disease. The bad impacts of smoking include:

• Bad effects of smoking
• Elevated  blood pressure
• Increased insulin resistance
• Injury to the lining of the coronary arteries by nicotine.
• Coronary artery  constriction
• Blood clots form and lodge in the coronary arteries.

Quitting smoking decreases the risk of a heart attack. The risk of heart disease decreases by 64 percent within  three years after stopping  smoking.

Alcohol by itself is a source of calories and contributes to caloric overload. Alcohol also acts as an appetite  stimulant  and there is increased  intake of food after alcohol consumption. Alcohol retards the burning  up of fat by the body. As a result fat burning  up of fat by the body  resulting in increased accumulated in the body resulting  in increased levels of triglycerides. All these factors collectivity  contribute to increase in blood sugar, abnormal lipid as well  as weight  gain.

• The combination  of the above factors is a deadly recipe for development  of CDMS.

How CDMS is detected?

• Waist and hip circumference  measurement
• Blood  pressure  measurements
• Blood sugar  test
• Lipid  profile test

Procedure for the blood test to diagnose CDMS

• Do not consume any food or drink after midnight till the morning  of the test.
• Water is permitted.
• Regular medication can generally be avoided until the sample has been taken.
• Blood is collected in the morning after fasting  for 8 hours.
• Management and prevention of CDMS

As CDMS is the root cause of some of the common clinical disorders like obesity, type II diabetes, high blood pressure and heart disease, it is important  to control CDMS. Rather than using drugs to control the abnormalities, preventing the abnormalities in the first place makes a lot more  sense.

Lifestyle Adjustment in CDMS:

The ideal way to control CDMS is to change our habits as well as lifestyle. The change should be gradual so that the changed habits become a routine part of the lifestyle. The lifestyle changes that need to be implemented are :

• A vegetarian diet low in saturated fats.
• Exercise
• Walking minimum 30-40 minutes a day six days a week , or one hour per day, three days in a week.
• Managing stress
• Yoga
• Pranayam or breathing exercises
• Mediation
• Shavasana  or deep relaxation
• Yog nidra or guided imagery
• Improving interpersonal  relations
• Better communication  with others
• Becoming more social to reduce isolation
• Controlling anger
• Reducing  smoking and alcohol consumption
• Developing a habit   of having  regular medical examination.