Do you know if you have risk factors for metabolic syndrome?
Metabolic syndrome is group of conditions that, together, raise your risk for heart disease, diabetes, stroke, non-alcoholic fatty liver disease, infertility, erectile dysfunction and other health problems (1, 2, 3).
The risk factors for metabolic syndrome include 3 or more of the following conditions:
1) Large waist size
2) High triglycerides
3) Low HDL (“good”) cholesterol
4) High blood pressure
5) High blood sugar
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Metabolic syndrome does not discriminate. In a 2020 study, published in JAMA, researchers analyzed survey data from over 17,000 people who were representative of the US population across gender, age, race and ethnicity (4).
What they found: While, the overall prevalence of metabolic syndrome increased somewhat between 2011 and 2016, it increased significantly for the following groups (5):
–Women: from 31.7% to 36.6%
–Young Adults, aged 20 to 39: from 16.2% to 21.3%
–Asian: from 19.9% to 26.2%
–Hispanic: from 32.9% to 40.4%
Though we often take it for granted, our metabolic health (cellular health) is KEY to our overall physical and mental health.
The good news?
Metabolic health is primarily lifestyle driven. If we understand what our metabolic risk factors are—and we know our numbers—we can improve metabolic health through our food choices, lifestyle habits and shifting our mindset around what being “healthy” actually means.
In my last email, I talked about why metabolic health matters and included the optimal ranges for each of the five biomarkers. If you missed it…you can read my post HERE.
How does each metabolic risk factor affect our chronic disease risk?
1. Large Waist size
Waist circumference can reveal a lot about your risk for heart disease—as well as other health issues. Large waist size = For men: 40 inches or more; For women: 35 inches or more.
Even if your Body Mass Index (BMI) is less than 25, and you are at a “normal” weight, having excess fat around the waist, also known as “central adiposity”, can raise your risk of high blood pressure, high cholesterol, Type 2 diabetes and heart disease (6).
Studies have shown that it is not just general overweight/obesity that increases risk of heart disease—it is where that fat is stored on the body.
In a study, published in the Journal of the American Heart Association, researchers tracked the lifestyle, environment and medical history—which included body measurements—of 480,000 study participants (both men and women), aged 40-69, over a period of seven years.
What they found: a higher waist-to-hip ratio (larger waist size) is strongly associated with greater risk of heart attack in both men and women, especially women (7).
According to a systemic review published in the Journal of Public Health Research, a large waist circumference increased the risks of developing (8):
–Hypertension
–Type 2 diabetes
–High cholesterol
–Joint pain
–Back pain
–Hyperuricemia: High levels of uric acid in the blood that can lead to gout and kidney stones
–Obstructive sleep apnea
2. High triglycerides
In my opinion, when it comes to cholesterol numbers, people need to pay more attention to their triglycerides (versus LDL cholesterol). Triglycerides are a type of fat found in the blood. Triglycerides are HIGH if 150 mg/dL or higher OR you are using a cholesterol medication.
Most triglycerides are made by your body from carbohydrates, including sugar and flour-based foods (like diet soda, breads, pasta, etc.), refined and processed starchy carbs (think store-bought cookies, cakes, snack foods and French fries, rice, etc.) and alcohol.
Triglycerides are a good marker of carbohydrate intake. High triglycerides of, say, 300 mg/dL, suggest that you are overconsuming carbohydrates. Triglycerides outside of the optimal range indicate that you likely have undesirable visceral fat—a dangerous type of fat that wraps around vital organs, like the liver, pancreas and kidneys.
Having higher triglycerides also means that you likely have an excess of small, dense low-density lipoprotein (LDL) particles that can lead to heart attack and stroke (9).
3. Low HDL “good” cholesterol
Unfortunately, if you have high triglycerides, you will very likely have low HDL cholesterol. For men: Low HDL = less than 40 mg/dL; For women: Low LDL = less than 50 mg/dL.
High density lipoprotein (HDL) is a class of lipoproteins that carry cholesterol in the blood. HDL cholesterol has been dubbed the “good” cholesterol because it removes excess cholesterol from tissues, carrying it back to the liver for removal from the body. HDL can help prevent build-up of plaque—excess cholesterol deposits on the walls of your blood vessels—which can constrict blood flow, increasing heart attack risk.
A study, published in the Journal of the American College of Cardiology, found that low HDL cholesterol levels were associated with a higher risk of death from cardiovascular issues as well as a higher risk of death from cancer and other causes (10).
In this study, researchers used a study cohort that consisted of 631,762 Ontario, Canada residents—55% women and 45% men with a mean age of 57—all of whom did NOT have a history of heart disease (e.g., heart attack, heart failure, stroke) or any conditions that reduced life expectancy (e.g., history of cancer, dementia, pulmonary embolism, etc.).
What they found: Low HDL was associated with an unhealthy lifestyle, higher triglyceride levels, other cardiac risk factors and medical problems.
Keep in mind: the association between low HDL cholesterol and worse cardiovascular outcomes could be due to factors such as an unhealthy lifestyle, high triglycerides, etc., and not the low HDL cholesterol itself (11).
Your HDL level is a good indicator of your overall metabolic health. HDL cholesterol that is at least 60 mg/dL is optimal. If your current HDL is low, start with lifestyle modifications. Note: Medications used to increase HDL cholesterol have not successfully lowered the rate of heart attack (12).
Losing weight and increasing insulin sensitivity through anti-inflammatory food choices and healthy lifestyle habits (e.g., regular exercise; restorative sleep; avoiding excess alcohol, trans fats and seed oils; and stopping smoking) can help raise HDL cholesterol (13).
4. High blood pressure
High blood pressure, or hypertension, is exceedingly common. Nearly half of U.S. adults have hypertension, defined as regularly having a blood pressure reading of >/=130 (systolic) / 80 (diastolic) mm Hg; or taking medication for hypertension (14).
High blood pressure damages the wall of your arteries, which enables plaque to build up in your arteries. Deposits of plaque can lead to blood clots. When these blood clots flow through your bloodstream and block blood flow to your brain or heart, this can result in a heart attack or stroke.
Hardened or narrowed arteries also mean that your heart has to work harder to circulate blood; this can cause your heart to become enlarged, unable to supply vital organs with blood, and increasing risk of heart failure (15).
Lifestyle strategies that can be effective in lowering blood pressure include: quitting smoking; losing weight; limiting alcohol consumption; making anti-inflammatory food choices; reducing intake of refined salt and processed salt; increasing physical activity; and managing stress perception (16).
5. High blood sugar
Chronically high blood sugar levels contribute to plaque buildup in your arteries, restricting blood flow to vital organs, like the brain; this can set the stage for heart disease, a heart attack or stroke.
A fasting glucose test and Hemoglobin A1c (HbA1c) both measure the amount of sugar in your blood.
A fasting glucose test provides a one-time snapshot of the amount of sugar in your blood in a fasted state—when you have not eaten or drank anything (besides water) for 8 to 12 hours.
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- Fasting glucose is 100 to 125 mg/dL = Pre-diabetes.
- Fasting glucose of 126 mg/dL or higher = Diabetes
On the other hand, Hemoglobin A1c (HbA1c) provides a longer-term view of blood sugar control because it measures your average blood sugar over a 3-month period. High HbA1c is strongly associated with an increased risk of heart disease in people with diabetes—and without diabetes (17).
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- A1c between 5.7% and 6.4% = Prediabetes.
- A1c is 6.5% or higher = Diabetes.
In a meta-analysis of 46 studies, published in BMJ Open, researchers assessed HbA1c and cardiovascular-related deaths for both non-diabetic and diabetic populations (18).
What they found:
For people without diabetes, an optimal HbA1c level was between 5.0% to 6.0%. For non-diabetics who had an HbA1c higher than 6.0%, the risk of death from heart disease rose significantly.
For people with diabetes, an optimal HbA1c level ranged between 6.0% and 8.0%. Among diabetics, an HbA1c higher than 8.0% was associated with a significantly greater risk of death from heart disease.
Blood sugar can be successfully managed through food choices and lifestyle modifications.
👉👉👉Are you tired of making lifestyle choices that leave you feeling physically exhausted, stressed, unmotivated and “stuck” when it comes to your health and well-being? Let’s get clear on what’s been holding you back from better metabolic health. Schedule a 1:1 Metabolic Health coaching session with me here. Until March 31st, you pay a special discounted March 2025 Spring Tune-Up rate of just $75 for a 1:1 with me.
Sources
1 Tang, J., Xu, Y., Wang, Z. et al. Association between metabolic healthy obesity and female infertility: the national health and nutrition examination survey, 2013–2020. BMC Public Health. 23, 1524 (2023).
2 Westerman R, Kuhnt AK. Metabolic risk factors and fertility disorders: A narrative review of the female perspective. Reprod Biomed Soc Online. 2021 Oct 1;14:66-74.
3 Martins AD, Majzoub A, Agawal A. Metabolic Syndrome and Male Fertility. World J Mens Health. 2019 May;37(2):113-127.
4, 5 Hirode G, Wong RJ. Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016. JAMA. 2020;323(24):2526–2528.
6 Klein S, Allison D, Heymsfield SB, Kelley DE., Leibel RL, Nonas C., Kahn R. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. The American Journal of Clinical Nutrition. 2007; 85:1197-1202. Printed in USA. © 2007 NAASO and the American Diabetes Association.
7 Peters SAE, Bots, SH, Woodward M. Sex Differences in the Association Between Measures of General and Central Adiposity and the Risk of Myocardial Infarction: Results From the UK Biobank. Journal of the American Heart Association. Vol. 7, No. 5. Feb. 28, 2018.
8 Darsini D, Hamidah H, Notobroto HB, Cahyono EA. Health risks associated with high waist circumference: A systematic review. J Public Health Res. 2020 Jul 2;9(2):1811.
9 Hori M, Imamura T, Narang N, Onoda H, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Triglyceride and Small Dense LDL-Cholesterol in Patients with Acute Coronary Syndrome. Journal of Clinical Medicine. 2021 Oct 8;10(19):4607.
10, 11 Ko, D, Alter, D, Guo, H. et al. High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions: The CANHEART Study. Journal of the American College of Cardiology. 2016 Nov, 68 (19) 2073–2083.
12, 13 “HDL Cholesterol: How to boost your ‘good’ cholesterol”. Mayo Clinic. Nov. 7, 2024.
14 “High Blood Pressure”. US Centers for Disease Control and Prevention (CDC). Jan. 28, 2025.
15 “High Blood Pressure”. UPMC. Apr. 17, 2024.
16 Whelton PK, Carey RM, Aronow WS. et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 June, Vol. 7, No. 6, Pages e13-3115.
17 Goto, Atsushi MD, PhD, MPH; Noda, Mitsuhiko MD, PhD; Matsushita, Yumi PhD; Goto, Maki MD, PhD; Kato, Masayuki MD, PhD; Isogawa, Akihiro MD, PhD; Takahashi, Yoshihiko MD, PhD; Kurotani, Kayo PhD; Oba, Shino PhD; Nanri, Akiko PhD; Mizoue, Tetsuya MD, PhD; Yamagishi, Kazumasa MD, PhD; Yatsuya, Hiroshi MD, PhD; Saito, Isao MD, PhD; Kokubo, Yoshihiro MD, PhD; Sawada, Norie MD, PhD; Inoue, Manami MD, PhD, MS; Iso, Hiroyasu MD, PhD, MPH; Kadowaki, Takashi MD, PhD; Tsugane, Shoichiro MD, PhD. Hemoglobin A1c Levels and the Risk of Cardiovascular Disease in People Without Known Diabetes: A Population-Based Cohort Study in Japan. Medicine. 94(17):p e785, May 2015.
18 Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et al. Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis. BMJ Open. 2017;7:e015949.
