While a low cholesterol score was once considered a sign of relative good health and a low risk of heart disease ... that may no longer be the case.

Doctors have been finding a group of people whose levels of LDL cholesterol (the so-called bad cholesterol) are low but who are still at an increased risk of atherosclerosis, heart attack and stroke. That's because they have a condition known as metabolic syndrome -- a group of symptoms including elevated levels of glucose, triglycerides and C-reactive protein and mild hypertension.

And while 55 million Americans meet the diagnostic criteria for metabolic syndrome, some scientists still disagree on:

• How to diagnose it
• What it should be called
• What causes the syndrome
• How to treat patients who have it

History of Metabolic Syndrome

In 1988, an endocrinologist at Stanford was the first to describe a cluster of low-level risk factors that tended to travel together and that significantly increased heart disease risk. He called it Syndrome X and noted that patients with the risk factors had low LDL levels as well.

It wasn't until three years later when a report by the National Cholesterol Education Program at the National Institutes of Health recognized this cluster of risks emphasized obesity as a central component, and renamed it the metabolic syndrome.

The report recommended the syndrome be diagnosed in people who had three to five of the following risk factors: a large waist, high triglycerides, low HDL, somewhat elevated blood pressure and elevated glucose.

Changes to be Made?

Today, some endocrinologists are concerned that list of criteria excludes patients who are insulin-resistant but aren't overweight or don't demonstrate any other symptoms (like East Indians). In fact, many endocrinologists prefer a different name for the condition: insulin-resistance syndrome.

And the American Association of Clinical Endocrinologists believes additional factors should be taken into account, including:

• Age
• Exercise habits
• Ethnic background
• Genetic predisposition
• A larger than normal body mass index

Some experts believe doctors should also look carefully for high levels of C-reactive protein because of its inflammation role, and say that fibrinogen (a protein that signals the body to form or break down blood clots) may be another possible risk factor of the syndrome to add to the mix.

Though regardless of what the main culprit behind the syndrome may be, research has proven that losing weight reduces all components of metabolic syndrome.

New York Times May 10, 2005