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Metabolic Syndrome and Cardiovascular Disease

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Metabolic Syndrome and Cardiovascular Disease

According to Mayoclinic.org ‘Metabolic syndrome’ (also called dysmetabolic syndrome or syndrome X) is defined as ‘a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes.1’ Metabolic syndrome is becoming increasingly common and is now recognised as a major causal factor in cardiovascular disease. Cardiovascular diseases (CVD’s) are any illnesses that involve the blood vessels (veins, arteries and capillaries) or the heart, or both - diseases that affect the cardiovascular system.2 Cardiovascular diseases are said to be the number 1 cause of death globally: more people die annually from CVDs than from any other cause.3 Cardiovascular diseases include blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects one may be born with (congenital heart defects), among others.4 Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies.3 As mentioned in the definition, hypertension and hyperglycaemia are 2 main features of metabolic syndrome that can lead to cardiovascular disease.
Hypertension, or high blood pressure, is a blood pressure reading of 140/90 or higher.5 It is caused by many factors and these include smoking, being overweight or obese, lack of physical activity, excess salt, excess alcohol consumption (more than 1 to 2 drinks per day) stress etc.6 Hypertension increases the risk of cardiovascular disease by first increasing haemodynamic stress in blood vessels which damages the endothelium (a thin single layer of cells that lines the inside of blood vessels)
An artery wall is composed of 3 layers : -The tunica Adventitia- the strong outer covering composed of connective tissue, collagen and elastic fibers -The tunica Media- the middle layer composed of smooth muscle and elastic fibers -The tunica Intima- the inner layer where the endothelium is found
When the endothelium is damaged thrombosis or atherosclerosis can occur. This is because platelets will adhere to the damaged endothelial layer and a thrombus will be formed as a healing response to the vessel. A thrombus is a clot (made of platelets and fibrin) formed within a blood vessel. The formation of the thrombus may block the artery (as seen in the diagram) and lead to an infarction- the death of a tissue if the thrombus is occluding the blood supply, which can then, in turn lead to cardiovascular disease.
Atherosclerosis can occur if the thrombus is formed on fatty cells on the vessel wall. Atherosclerosis, also known as the hardening of the arteries, is defined as a narrowing of the arteries caused by a build up of plaque. It begins as these vessels having naturally occurring fatty streaks early on in life. If the diet of the individual is then high is saturated fat, it will lead to the growth of fat-containing cells, which are termed as foam cells. These cells will then form the core of the plaque in the vessel wall, this is known as atherosclerotic plaque. If damage occurs to the vessel and a thrombus is formed on top of the plaque, a blockage can occur which could also lead to heart disease.
The most frequently deadly result of atherosclerosis is coronary artery disease, a disease in which plaque builds up inside the coronary arteries that supply oxygen-rich blood to your heart muscle.
In order to treat atherosclerosis, some steps can be taken. Apart from medication, lifestyle changes can be made and these include a healthy diet, exercise and no smoking. It is important to note that these changes won't remove blockages, but they are proven to lower the risk of heart attacks and strokes. Coronary artery bypass surgery and angiographs can also be performed.

Hyperglycaemia (high glucose levels of blood) is a sign/symptom of type 1 and type 2 diabetes. Glucose is a carbohydrate and is important in human metabolism (provides energy). It is a single sugar unit with the formula C6H12O6. Its levels in the blood are controlled by 2 hormones made in the pancreas (specifically in the islets of Langerhans); Insulin and glucagon. Insulin increases glucose entry into cells while glucagon increases blood glucose concentration.
Type 1 diabetes occurs when antibodies attack the beta cells that secrete insulin, which in turn causes a loss of insulin secretion. This leads to reduced cell uptake of glucose resulting in hyperglycaemia. In order to treat this form of diabetes a consistent supply of insulin is needed and this is done via lifelong insulin injections. The aim of the treatment is to relieve the symptoms or delay the complications by targeting normal glucose levels.
Type 2 diabetes, also known as non-insulin dependent mellitus, occurs when the body does not use insulin properly i.e. insulin resistance. Insulin resistance is caused by obesity and leads to hyperglycaemia (constant high insulin output from the pancreas is thought to lead to beta cell death). In Type 2 diabetes the patients are treated with diet/ exercise and sometimes oral medications and/or insulin.
Type 1 and Type 2 diabetes have many of the same signs and symptoms including hyperglycaemia, glucosuria (high levels of glucose being excreted in the urine), polyuria (excess passage of urine), and weakness/fatigue/ weightloss. The only difference between the symptoms of type 1 and 2 diabetes is that type 1 diabetes usually occurs earlier on in life and ketoacidosis (where a high concentration of keytones are formed due to excessive lipid metabolism) can occur while there is a gradual onset of type 2 diabetes and ketoacidosis usually does not occur.
Early symptoms of hyperglycaemia include: frequent urination, increased thirst, blurred vision, fatigue and headache. These symptoms develop slowly over years but is very important to take heed to these symptoms as if it is left untreated, hyperglycaemia can become severe and lead to serious complications requiring emergency care, such as diabetic coma. In the long term, if hyperglycaemia persists, even if not severe, it can lead to complications affecting your eyes, kidneys, nerves and heart. Later signs/symptoms of hyperglycaemia include fruity-smelling breath, nausea and vomiting, shortness of breath, dry mouth, weakness etc.7
Hyperglycaemia is also said to increase the levels of LDL’s in the blood. LDL’s are low density lipoproteins while HDL’s are high density lipoproteins. These lipoproteins both carry cholesterol, a type of fat that is hydrophobic and does not dissolve in blood. HDL’s (good cholesterol) removes cholesterol from tissues and takes it to the liver for disposal while LDL’s deposit the fat to tissues, including the wall of arteries and this helps to form atherosclerotic plaque. The vessels are then blocked with plaque, which causes a blockage, leading to an infarct (tissue death) then heart disease.

Hypertension and hyperglycaemia are both features of metabolic syndrome that increase the risk of cardiovascular disease. These features as well as cardiovascular disease are life-threatening and precautious steps should be taken to prevent or treat them.

REFERENCING 1. Mayoclinic.org. [internet] Metabolic Syndrome. 2014 Aug 22 [cited 2015 Mar 31]. Available from: http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/basics/definition/con-20027243 2. Medicalnewstoday.com. [internet]. What is Cardiovascular disease? What Causes Cardiovascular Disease? Updated 2014 Sep 5 [cited 2015 Mar 31]. Available from: http://www.medicalnewstoday.com/articles/257484.php 3. World Health Organization (WHO). Cardiovascular Diseases (CVDs). Updated 2015 Jan [cited 2015 Mar 31] 4. Mayoclinic.org. [internet]. Definition. 2014 July 29 [cited 2015 Mar 31]. Available from: http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/definition/con-20034056 5. Irish Heart Foundation. About hypertension. [cited 2015 Mar 31]. 6. Webmd.com [internet]. Causes of High Blood Pressure. [cited 2015 Mar 31]. Available from: http://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes 7. Mayoclinic.org. [internet] Hyperglycaemia in diabetes. 2012 Jun 14 [cited 2015 Mar 31]. Available from: http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/definition/con-20034795 8. All other information was taken from lectures: Physiology, Anatomy & Biomolecules. Lecturers: Gordon Reid, Andre Toulouse and John Mackrill.
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1. https://www.google.ie/search?q=atherosclerosis&espv=2&biw=1366&bih=667&site=webhp&source=lnms&tbm=isch&sa=X&ei=DdAaVfODDca57gbJ1YGQCQ&sqi=2&ved=0CAYQ_AUoAQ&dpr=1#imgdii=_&imgrc=CpIYgnIr7qGPmM%253A%3BGdzMpkpht7EpqM%3Bhttp%253A%252F%252Fwww.pharmaceutical-networking.com%252Fwp-content%252Fuploads%252F2011%252F01%252FAtherosclerosis-Diagram.bmp%3Bhttp%253A%252F%252Fwww.pharmaceutical-networking.com%252Fmerck-mk-0524b-treatment-of-atherosclerosis%252F%3B625%3B417
2. https://www.google.ie/search?q=hyperglycemia&espv=2&biw=1366&bih=667&source=lnms&tbm=isch&sa=X&ei=AM4aVafSN66P7Aa26YDQBg&ved=0CAYQ_AUoAQ#imgdii=_&imgrc=GDSbU0iMFjrc0M%253A%3BUnci2gbpmIbvwM%3Bhttp%253A%252F%252Fwww.theresearchpedia.com%252Fsites%252Fdefault%252Ffiles%252Fsymptoms%252Fhyperglycemia.jpg.pagespeed.ce.l8URDR-OYR.jpg%3Bhttp%253A%252F%252Fwww.lookfordiagnosis.com%252Fmesh_info.php%253Fterm%253Dhyperglycemia%2526lang%253D1%3B290%3B232

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