METABOLIC SYNDROME KEY POINTS

1.Metabolic syndrome is
increasing but often goes
unrecognised.

2.Measuring insulin resistance is
unnecessary – measuring waist
circumference is simpler and
more important.

3.Ethnicity needs to be
considered when cut-off points
for waist measurement are used
to screen for patients at risk of
metabolic syndrome.

4.Risk factors for metabolic
syndrome often cluster together,
and the increase in risk is
multiplied rather than added.

5.Modest weight loss (5kg) and/or
increased physical exercise
reduce the risk of developing
diabetes in patients with metabolic syndrome.

Waist Target Parameters

Country/ethnic group Waist circumference

Europids Male 􀀪 94 cm
In the US, the Female 􀀪 80 cm
ATP III values
(10 cm male;
88cm female)
are likely to
continue to be
used for clinical
purposes.
South Asians Male 􀀪 90 cm
Based on a Female 􀀪 80 cm
Chinese, Malay
and Asian-Indian
population
Chinese Male 􀀪 90 cm
Female 􀀪 80 cm
Japanese Male 􀀪 90 cm
Female 􀀪 80 cm
Ethnic South and Use South Asian
Central Americans recommendations until
more specific data
are available.
Sub-Saharan Use European data until
Africans more specific data are
available.
Eastern Use European
Mediterranean data until more specific
and Middle East data are available.

Preventing Recurrent DVT

A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
• Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
• Ask for a seat with good leg room
• Accept every non-alcoholic
beverage offered
• Minimise alcohol consumption
• Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
2. TGA-approved product information for

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