The revised government guidelines for managing high cholesterol include a strong recommendation to identify and treat the "metabolic syndrome." This condition is a cluster of factors such as too much abdominal fat (as indicated by a larger than normal waistline measurement), elevated blood pressure, elevated triglycerides, and low HDL (the "good" cholesterol). It is closely linked to insulin resistance, an underlying cause of type 2 diabetes. Insulin controls the body's metabolism of carbohydrates, fats and protein, and insulin resistance is associated with excess body fat, particularly in the abdomen, and physical inactivity.

An individual with 3 or more risk factors (see table) is considered to have the syndrome and should be treated.

Identifying Metabolic Syndrome

Risk Factor	Defining Level
Abdominal obesity - waist circumference	Men: > 40 in Women: > 35 in
Trigylcerides	150 mg/dL or higher
HDL cholesterol	Men: < 40 mg/dL Women: <50 mg/dL
Blood pressure	130/85 mm Hg or higher
Fasting glucose	110 mg/dL or higher

The panel recommends lifestyle changes, particularly weight control and physical activity, to treat the metabolic syndrome and its underlying causes.

Related information About it - other risk factors