Complications
Metabolic syndrome increases risk of cardiovascular disease (CVD) and major adverse cardiovascular events.[185] Patients with metabolic syndrome have a 2 to 3 times higher risk of CVD-related mortality.[186] The combination of metabolic syndrome with diabetes increases CVD risk nearly 5-fold.[187]
A large meta-analysis of 172,573 patients with metabolic syndrome showed that their relative risk (RR) of cardiovascular events and death was 1.78. This association remained high (RR of 1.58) after adjustment for traditional cardiovascular risk factors and was greater for women than for men.[188]
Another study showed an increased risk of stroke (hazard ratio of 1.5) in patients with metabolic syndrome after adjustment for sociodemographic risk factors.[189]
Even in adolescents, metabolic syndrome has been associated with increased carotid intima-media thickness.[190]
MASLD (previously known as non-alcoholic fatty liver disease) is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. It is common, with a global prevalence of around 25% and wide variations between regions and by ethnicity.[194]
MASLD is a long-term comorbidity associated with metabolic syndrome. It is considered the hepatic manifestation of metabolic syndrome and is strongly associated with its components (obesity, dyslipidaemia, insulin resistance).[173] People with metabolic syndrome have a 4-11 times higher risk of developing future MASLD.[195]
MASLD is also strongly associated with cardiovascular disease, even after adjustment for metabolic syndrome risk factors.[196]
Patients with elevated aminotransferases and metabolic syndrome should be referred to a hepatologist.
CKM syndrome is a disorder defined by the American Heart Association (AHA) to reflect the connections between metabolic disease (obesity, diabetes, metabolic syndrome), kidney disease, and cardiovascular disease (CVD).[204]
It includes both individuals at risk for CVD (due to the presence of metabolic risk factors, CKD, or both) and individuals with existing CVD, including heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral artery disease.
The AHA recommends that these patients are managed by an interdisciplinary team with targeted referral of high-risk CKM patients to appropriate subspecialists. They also emphasise that clinical care should include addressing social determinants that affect CKM health.[204]
Metabolic syndrome has been associated with both male and female (independently of polycystic ovary syndrome) hypogonadism. Hypogonadism is also a risk factor for metabolic syndrome and type 2 DM. Hormone replacement therapy in both sexes ameliorates the features of metabolic syndrome.[4]
Obesity is strongly associated with osteoarthritis, particularly of the knees, in patients with metabolic syndrome.[197]
Accumulating epidemiological evidence has linked metabolic syndrome with the development or progression of cancer: in particular, colorectal and prostate cancer, and an increased recurrence of breast cancer.[198][199][200] The increase in hepatocellular carcinoma has also been linked to an increased prevalence of metabolic syndrome.[201]
Obesity is significantly associated with higher rates of development of and death from the most common cancers, including colorectal, prostate, breast, and liver cancer.[202]
Type 2 DM is also associated with an increased risk of developing cancer in general and of developing cancer in specific sites.[203]
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