Thursday, January 28, 2016

American Academy of Orthopaedic Surgeons releases guidelines for surgical treatment of osteoarthritis of the knee

By: Michael F. Blum, MD
Orthopaedic Surgeon Southlake Orthopaedics and Sports Medicine & Spine Center, PC

Recently the American Academy of Orthopaedic Surgeons (AAOS) introduced new clinical practice guidelines for adults undergoing surgery to recover motion and relieve pain caused by osteoarthritis of the knee. The guidelines focus on the surgical procedure most commonly performed for this condition, total knee replacement.

In cases where surgery is warranted, the clinical based guideline is the first evidence-based guideline for diagnosis, treatment, rehabilitation and safety for patients. The guidelines are timely because total knee replacement is the No. 1 procedure, in terms of costs, reimbursed by the Centers for Medicare and Medicaid Services (CMS). Effective April 2016, CMS will issue bundled payment for total knee replacement in designated geographic markets—one fixed cost reimbursement for everything from initial consult through recovery.

The clinical based guideline, “Surgical Management of Osteoarthritis of the Knee,” provides guidelines for physicians and patients to consider when making decisions about knee replacement.

Among the key clinical practice guidelines receiving “strong” rating are:

• Reduction of risk factors such as weight reduction and stop smoking

• Administration of multi-modal anesthesia, including local anesthetic and nerve blockade around the knee joint to decrease pain and opioid use following total knee replacement

• Starting rehabilitation the same day total knee replacement is performed to reduce length of hospital stay.

For patients who I am seeing and discussing total knee replacement, I encourage them to focus on pre-operative strengthening of the quadriceps. The stronger a patient’s quadriceps, the faster the recovery postoperatively is the message I share. The more pre-operative education the patient understands and receives regarding “replacing” a joint attributes to the outcome of the procedure. The success of joint replacement relies heavily on the patient knowing what to expect and their role in the recovery phase.

Monday, January 25, 2016

Have You Had Your Annual Checkup?

By: Patrick Carlton, Senior Vice President-Private & Professional Banking Manager at National Bank of Commerce.

If you are like me, you start each New Year with fresh ideas, recently crafted resolutions, and the determination to make the coming year better than the last. Whether it is for your practice or your personal finances, a review of your banking needs and what services best match those needs should be at the top of your list in “organizing and reorganizing” your finances. Here are a few tips that can help increase profitability and productivity - or just make life easier.

1. Evaluate your capital needs for the year.

 Do you plan to buy a new piece of equipment, bring on a new employee, open a new location, or build a new office? Maybe you plan to buy a new house or you have college or wedding expenses? Or are you simply trying to just stay the course?

In all of these scenarios, it’s a good idea to strategize with your banker and outline your expectations. Your banker should fully understand your objectives and advise you on the available tools needed to accomplish your goals.

2. Review your rates and fees.

 A thorough review of your banking, merchant services, and credit card statements can often reveal opportunities for savings. Maybe interest rates are more competitive now or maybe you are no longer using a service but are still paying for it. If you are unsure of charges, be sure to inquire. You may find you are overpaying – oftentimes for something as simple as viewing your accounts online. One thing we often see is unnecessary service charges that are a result of not performing a regular and basic review of your statements.

As a reminder, while it can be a factor, you should never choose a bank based solely on finding the lowest cost provider!

3. Learn if you are behind the times.

 Make sure you are using all the technology available to make your life easier. Remote deposit capture, EDI, and ACH can help create efficiencies and improve internal controls. Rebated foreign ATM fees, Smartphone apps with mobile deposit, and P2P payments are all great ways to simplify your personal banking.

As I have said before, there are a lot of challenges and worries in healthcare today--margins are lower, risks are higher, and regulations continue to grow. However, a strong relationship with your banker will help improve your bottom line and your piece of mind.


What of HIPAA without MU?

By: Susan Pretnar, President KeySys Health, LLC

Turns out folks jumped the gun recently, celebrating the imminent demise of Meaningful Use. Many probably hoped that meant HIPAA Security could simply go back to sleep. Karen DeSalvo, National Coordinator for Health Information Technology, quickly clarified remarks made by CMS Acting Administrator, Andy Slavitt, assuring the healthcare industry that MU is not going away any time soon. In truth, even if MU (or the HITECH Act itself) were to be sunset, HIPAA endures.

Because most healthcare organizations routinely address HIPAA Privacy concerns, the potential for data leaks due to poorly implemented HIPAA Security controls dwarf privacy breach risks in the rapidly expanding digital healthcare world. If statically accurate, the vast majority of hospitals and physician practices are now utilizing electronic medical records. Even if they hate their EHR applications, they aren’t going back to paper. Laptops, smartphones, and tablets, plus 7 x 24 access, are de rigueur. Even so, lack of attention or outright resistance to safeguarding networks and devices, or the data on them, is also common.

Apparently, MU is going to morph into a program more focused on interoperability and patient outcomes. One wonders exactly what ‘data’ will be used to support improvements in outcomes. If the data already defined by MU or PQRS is not sufficient, what other ingredients need to be added to measure improvement, and who must add them? A serious problem with any measurement is the industry’s notorious failure to resolve 2 critical standards: the patient identifier, and the definitive composition and definition of the clinical medical record. Without a consensus for these key data components, sharing and merging of longitudinal patient information is still way over the horizon.

Barriers are aplenty in the effort to achieve interoperability and better health outcomes. Why is HIPAA so important to this discussion? We are steadily and rapidly increasing our reliance on electronically created, stored and transmitted protected health information. The choice seems to be spending money to secure it, or spending even more money to defend why it got away.

Thursday, January 21, 2016

People with Parkinson

By: HealthSouth Lakeshore Rehabilitation Hospital Outpatient Clinic

People with Parkinson’s disease who are participating in a high-intensity, high-frequency rehabilitation program at HealthSouth Lakeshore Rehabilitation Hospital are seeing results from their efforts. The therapy, called LSVT BIG, is a derivative of the Lee Silverman Voice Therapy used by speech therapists and promotes high-amplitude movements in people with Parkinson’s disease. Sonya Pearson, PT, DPT and Cheryl Pierce, OT are certified in the delivery of LSVT BIG and say the BIG protocol was developed specifically to address the unique movement impairments for these Parkinson’s patients.

BIG exercises are whole body multidirectional exercises. The basic principles of LSVT BIG include high effort, progressive movements, continuous activity, and are directly aimed at increasing the amplitude of movement during everyday activities.

The program schedule includes 16 individual therapy sessions delivered four days a week over four continuous weeks by certified physical or occupational therapists. “During a typical one-hour LSVT BIG session, participants perform repetitious exercises which include whole body movements, functional component tasks and BIG walking trials,” Pearson says. “In addition to the high frequency of delivery, participants perform LSVT BIG carryover exercises and practice at home during the course of their treatment. This high level of intensity and frequency assists in increasing the amplitude and speed of movement in their everyday lives.”

To learn more, please contact HealthSouth Lakeshore Rehabilitation Hospital Outpatient clinic at 205.868.2290.

Wednesday, January 20, 2016

Glaucoma: The Silent Thief of Vision

By: Dr. Micah J. Kinney with UAB eye care

International celebrity icon, Bono, surprised the world this past October with his announcement, “I have glaucoma.” He admitted to dealing with the disease for over two decades. With January being Glaucoma Awareness Month, it is important to bring attention to a silent, painless, and blinding disease.

So what is glaucoma? Glaucoma is a disease where the optic nerve becomes damaged, typically as the result of increased intraocular pressure (IOP). This damage to the optic nerve and its fibers leads to permanent vision loss. As with most medical conditions, glaucoma comes in many forms and can be the result of secondary etiologies such as ocular trauma. Normal tension glaucoma (NTG) is a common form that manifests itself under normal IOP conditions. Bono stated in his interview in October that he would get vision screenings and could see 20/20, but it wasn't until further testing that he was diagnosed with glaucoma. If visual acuities and IOP alone are not diagnostic, then what is?

Both the American Optometric Association and the American Academy of Ophthalmology recommend people of all ages to undergo regular comprehensive dilated eye exams, as glaucoma can effect all ages. During a thorough exam, a stereoscopic view of the optic nerve can reveal if there is nerve damage or suspicion for further testing of the optic nerve function and retinal nerve fiber layer.

Who is at risk for glaucoma? Individuals over the age of 60, and especially African Americans over the age of 40 are the most at risk. Family history of glaucoma and any previous history of ocular trauma can contribute significantly. Other medical conditions such as diabetes, high blood pressure, and heart disease have been shown to increase the risk of developing glaucoma. Patients who are on chronic corticosteroids should also be screened for glaucoma.

As Bono can attest, the treatments that are available for glaucoma have improved over the years. While a cure is not yet available, patients with a glaucoma diagnosis can be managed and controlled for years with good compliance. Initial treatment consists of topical ocular medications such as prostaglandins, beta-blockers, alpha-adrenergic agonists, and/or carbonic anhydrase inhibitors. Surgical interventions have improved and can involve laser therapy or shunt placement.

Overall, glaucoma is a silent thief of vision. It is important to have regular comprehensive eye exams to ensure good ocular health. For more information on Glaucoma Awareness Month check out:

To schedule a comprehensive eye exam or consultation with UAB Eye Care, please call (205) 975-2020. We accept most vision and medical insurance plans.

Tuesday, January 12, 2016

Health Care Delivery System Innovation in the States

By: Leonard "Jack" Nelson III JD LLM

Jack is Professor Emeritus and faculty in the Master of Science in Health Law and Policy at Samford University’s Cumberland School of Law.

Politicians in both parties may be slouching toward another attempt at health care reform at the federal level. Republican Presidential candidates have been focused on the mantra of repeal and replace with the hope that the dissatisfaction of the Affordable Care Act will be their ticket to control of Congress and the Presidency. On the other hand, Democrats want to build on the successes of the Affordable Care by reforms increasing access to health care: Bernie Sanders favors “Medicare for All” and Hillary Clinton favors repeal of the Cadillac Tax and measures to blunt the impact of high deductibles on access to care for those who have insurance.

There is one clear lesson to be learned from the polarization over the ACA: imposing transformative change over 1/6 of the economy is inadvisable without broad bipartisan support. There is fundamental disagreement among policymakers in red and blue states over the respective roles of government and markets in private sectors in health care. This is not surprising in light of the fact that the United States is not a homogeneous nation. Different states have different histories, cultures, demographics, and socio-economic circumstances that can influence preferences for structuring the delivery and financing of health care services. It may be impossible to achieve consensus on substantive health care reforms at the federal level due to basic disagreements on the role of health insurance.

One of the key issues that Democrats and Republican disagree on is the role of “moral hazard” in health care spending. Moral hazard refers to the effect of insurance on the behavior of the insured. Thus in the health insurance context the question is whether the presence of insurance will increase health care expenditures. Most Republicans believe that moral hazard is a serious problem with health insurance, and believe that skimpier coverage will decrease health expenditures without adverse effects on health by decreasing unnecessary care and reducing prices. They typically support consumer driven health plans (CDHPs) that couple high deductible policies with tax-favored Health Savings Accounts (HSAs) to cover routine expenses.

On the other hand, many Democrats believe that the consumption of health care is primarily driven by health status rather than the problem of moral hazard. They don’t believe that providing people with more generous health insurance coverage will necessarily increase costs. In fact, many believe that increased access to preventive services could actually reduce health care expenditures. For example, Bernie Sanders favors a single payer system (“Medicare for All”), and Hillary Clinton favors measures to provide access to care without a deductible.

This ideological polarization is likely to continue. One solution to this problem is to allow increased flexibility for reforms at the state level as an alternative to the dysfunctional gridlock at the federal level. And in fact, this option is already available under the ACA in the form of a state innovation waiver under section 1332. This obscure provision authorizes the secretary of HHS to grant waivers beginning in 2017 that will exempt states from some of the specific requirements of the ACA (e.g., individual mandate and health insurance exchanges). In order to obtain a 1332 waiver, a state must establish that its innovations would: (1) comprehensive coverage to as many people; (2) provide coverage and cost sharing provisions at least as affordable; (3) provide coverage of a comparable number of residents; and (4) not increase the federal deficit.

The ACA was developed in the context of an existing health care system that includes a peculiar assortment of private and public insurance programs that are based on these conflicting approaches. It essentially doubles down on this complex and incoherent mixed system. One problem, however, with reinforcing this mixed system is the difficulty in determining which approaches are most effective in terms of reducing costs, increasing access, and enhancing quality. But decentralization could facilitate the development of more evidence-based health policy making by encouraging experimentation with diverse approaches in the laboratory of the states.

Both Democrats and Republican should consider relaxing the requirement that coverage be at least as comprehensive as the Affordable Care Act in order to facilitate experimentation at the state level. While some may argue that it would be better for Republicans to do nothing while Affordable Care implodes and then use this failure to push for a full repeal, such a strategy is not without risk. If the private insurance system is undermined, and the efficacy of alternatives to single payer have not been established, it may be easier for Democrats to push for a single-payer system that could initially be implemented under innovation waivers at the state level. For Republicans, successful demonstrations of the use of CDHPs at the state level could head off adoption of a nationwide “Medicare for All.” Retaining the ACA while clearing the way to permit states to experiment with CDHPs beginning in 2017 may be a sensible approach. And Democrats should be concerned that the ACA could be undermined by the inability to entice a sufficient number of younger/healthier persons to enroll in coverage through the Marketplace Exchanges.

Thus it may be possible for Republicans to work with Democrats to expand the possibilities for experimentation with CDHPs in the states. This cooperation could include relaxation of the requirements of 1332, and bipartisan oversite of waiver applications. This approach should be coupled with legislation that would enable states to use Medicaid funds under section 1115 waivers to establish programs modeled on the Healthy Indiana Plan that enrolls low income people in CDHPs. Innovative incremental change at the state level is the most appropriate strategy for both Republicans and Democrats at this time.

Leonard J. Nelson, III, is Professor Emeritus and teaches in the Master of Science in Health Law and Policy at Samford University’s Cumberland School of Law.

Thursday, January 7, 2016

Healthy Ways to Eat Out!

By: Chef John Hall Post Office Pies

The New Year is here and we all know what that means, resolutions! Most people start eating right and working out on January 1st, but they also stop eating out! That’s why at Post Office Pies were so excited to do this blog series with the Birmingham Medical News.

Most people think eating at a pizza restaurant cannot be done when they’re on a diet - but think again! It’s all about how you order and it can be as simple as the right crust and toppings! Ask for thin crust, less cheese, and load up on the veggies! You can also choose a lean protein like chicken or skip the protein and go full veggie! The main key is practicing portion control! We know pizza is delicious but once you learn to manage the amounts you eat it’ll get easier to do this diet business.

At Post Office Pies, we offer seasonal salads year round and this is another easy way to eat with us! Our best seller this time of year is the Roasted Beets salad. This salad includes red and golden beets with arugula and a pecan granola. Our favorite ingredient in this salad has to be the golden beets which are good for the heart, kidneys, provide antioxidants, and can help lower blood pressure and cholesterol! We created an easy salad recipe featuring golden beets for our fans to try at home when you aren’t able dine in at Post Office Pies.

Golden Beet Salad with Toasted Walnuts

Prep time: 15 minutes

Cook time: 60 minutes

Total time: 75 minutes

Yield: 4 salads

What you’ll need:

● 2 large golden beets, or 4 small golden beets
● 1 tablespoon olive oil
● 3/4 cup apple cider vinegar
● 3 cups arugula or other green
● 1/2 cup toasted walnuts
● Zest from one lime
● Feta cheese or crumbled goat cheese

How to Cook It:

1. Preheat the oven to 450 degrees F. Rinse beets and coat them with the olive oil. Wrap in foil and place on a baking sheet. Bake for one hour, or until tender all the way through (test with a fork).

2. In a small saucepan, bring vinegar to a simmer and let simmer until it is reduced by one third. Let cool.

3. When the beets have cooled, peel and slice into rings. Toss them with the reduced vinegar.

4. Place a handful of arugula in the center of a plate, drizzle with a little olive oil, and top with the golden beet slices. Sprinkle a little of the lime zest, a handful of the toasted walnuts and a bit of crumbled feta or crumbled goat cheese.

Add pepper to taste over the top, serve, and enjoy!

Wednesday, January 6, 2016

A better way to a healthier community, Part 2.

By: Anne-Laura Cook, MD, FACP, MHCM Medical Director, Population Health Management & Primary Care Innovation Baptist Health Centers

Five Modifiable Risk Factors to Prevent or Control Chronic Disease:

• Tobacco Use

• Diabetes and Prediabetes

• High Cholesterol

• High Blood Pressure

• Excess Weight and Physical Inactivity

In September, I wrote about two risk factors, Tobacco Use and Diabetes/Prediabetes. In this post, we will discuss the other three:

High Blood Pressure
High Cholesterol

Heart disease is the number one killer of women and men in the United States, and high blood pressure and high cholesterol are major risk factors for heart attack and stroke. Surveys show that more than 44 percent of Alabamians who have had their blood cholesterol checked were told that is was too high. More than 40 percent of adult Alabamians have been told they have high blood pressure (Source: BRFSS 2013).

Most people know that lifestyle changes – improving your diet, exercising more, losing weight, stopping smoking – can improve your blood pressure and cholesterol levels. However, making these changes often feels like an extremely difficult task. In Baptist Health System’s Be Well program, we help individuals set and keep attainable goals – using small steps of change to increase motivation and achieve big picture success over time. Through motivational interviewing, we determine an individual’s desire to change, confidence about change and readiness to change. We then create a plan, including setting specific self-management goals. We then monitor progress towards and address barriers to achieving these goals.

Although lifestyle change is emphasized, medications are often necessary in order to properly treat high blood pressure and high cholesterol, but medication only helps if you take it. Multiple studies have shown that approximately 50 percent of patients diagnosed with a chronic illness (including high blood pressure and high cholesterol) do not take medications as prescribed. In our Be Well program, we are proactive in addressing barriers to medication adherence. Understanding that financial barriers are one of the most common causes of lack of adherence, we assess and explain the out-of-pocket costs of medication on each employer’s health plan prior to prescribing a medication. At each visit, patients are asked to assess their degree of medication adherence and are encouraged to talk about the reasons why they struggle to take medication as prescribed. Is it an annoying side effect they associate with a particular medication? Do they always forget their morning dose because their medication isn’t strategically placed to remind them to take it each day? We tackle these hindrances to care in partnership with our patients, creating a plan that works well for each individual.

Excess Weight and Physical Inactivity

It is no secret that Alabama has a weight problem. According to recent data, 33.5 percent of adults in Alabama are obese (Source: RWJF, The state of obesity, 2015). Perhaps because this health problem is so pervasive in our community, we have come to accept excess weight as normal. That’s a problem for our long-term physical and economic health. It is estimated that obesity-related conditions costs more than $190 billion a year in medical spending in the United States (Source: Cawley J, Meyerhoefer C. The medical costs of obesity. Journal of Health Economics. 31(1):219-230. 2012.).

We know this issue is challenging from a big picture perspective, and it is challenging for the individual, too. Staring down a 50+ pound weight loss goal (or more) often seems like an insurmountable task. This is where small steps of change can have the greatest impact. Instead of focusing on an ideal weight goal, focus on the first five pounds. Rather than eliminating temptations from your diet, focus on cutting back unhealthy items or substituting healthier choices for a few servings of the foods or drinks that you know provide you with more calories than you need.

When we need to lose weight, we often put most of our focus on improving our diet; however, increasing our activity can have the greatest impact on health. Making small changes such as taking the stairs, parking at the far end of the parking lot, or taking a 10-minute walk break every two hours during the work day can make a tremendous difference in your metabolism, revving up your body’s ability to efficiently process the food that you eat. Asking friends or colleagues to join you in your activity can also bolster your confidence since you are accountable to someone else. We frequently find it easy to let ourselves down; it is harder to disappoint someone else.

Baptist Health System wants to change the way you think about your health. We want to prepare you to take better care of yourself and help you prevent chronic illness. We want you to spend more time doing the things that matter to you – we want you to Be Well.

Monday, January 4, 2016

Do You Have The “Metabolic Syndrome”?

By: Sheela Lohiya, MD
Grandview Medical Group
Clinical Endocrinologist Board certified in Endocrinology, Diabetes and Metabolism

The metabolic syndrome (syndrome X, insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM). The major features of the metabolic syndrome include central obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hyperglycemia, and hypertension.

Risk Factors

Being overweight/obese, having a sedentary lifestyle, aging, having diabetes mellitus, CVD, lipodystrophy etc. confers risk.


1) Insulin Resistance

This is caused by an incompletely understood defect in insulin action. The onset of insulin resistance is heralded by postprandial hyperinsulinemia, followed by fasting hyperinsulinemia and, ultimately, hyperglycemia.

2) Increased Waist Circumference

Waist circumference is an important component of the most recent and frequently applied diagnostic criteria for the metabolic syndrome. However, measuring waist circumference does not reliably distinguish increases in subcutaneous adipose tissue vs. visceral fat; this distinction requires CT or MRI.

3) Dyslipidemia

Hypertriglyceridemia is an excellent marker of the insulin-resistant condition. The other major lipoprotein disturbance in the metabolic syndrome is a reduction in HDL cholesterol.

4) Glucose Intolerance

The defects in insulin action lead to impaired suppression of glucose production by the liver and kidney and reduced glucose uptake and metabolism in insulin-sensitive tissues, i.e., muscle and adipose tissue. The metabolic syndrome is a fairly strong predictor of incident diabetes in many populations and that it predicts diabetes more strongly than it predicts coronary heart disease events.

5) Hypertension

The relationship between insulin resistance and hypertension is well established.

6) Proinflammatory Cytokines

Symptoms and Signs

The metabolic syndrome is typically not associated with symptoms! On physical examination, waist circumference may be expanded and blood pressure elevated. The presence of one or either of these signs should alert the clinician to search for other biochemical abnormalities that may be associated with the metabolic syndrome. Less frequently, lipoatrophy or acanthosis nigricans is found on examination.


The diagnosis of the metabolic syndrome relies on satisfying the criteria listed in Table 1 by using tools at the bedside and in the laboratory. The medical history should include evaluation of symptoms for OSA in all patients and PCOS in premenopausal women. Family history will help determine risk for CVD and DM. Blood pressure and waist circumference measurements provide information necessary for the diagnosis.

Laboratory Tests

Fasting lipids and glucose are needed to determine if the metabolic syndrome is present. The measurement of additional biomarkers associated with insulin resistance can be individualized. Such tests might include apoB, high-sensitivity CRP, fibrinogen, uric acid, urinary microalbumin, and liver function tests. A sleep study should be performed if symptoms of OSA are present. If PCOS is suspected on the basis of clinical features and anovulation, testosterone, luteinizing hormone, and follicle-stimulating hormone should be measured.

Treatment: The Metabolic Syndrome


Obesity is the driving force behind the metabolic syndrome. In general, recommendations for weight loss include a combination of caloric restriction, increased physical activity, and behavior modification.


A high-quality diet— i.e., enriched in fruits, vegetables, whole grains, lean poultry, and fish—should be encouraged to provide the maximum overall health benefit.

Physical Activity

Although increases in physical activity can lead to modest weight reduction, 60–90 min of daily activity is required to achieve this goal.


In some patients with the metabolic syndrome, treatment options need to extend beyond lifestyle intervention. Weight-loss drugs come in two major classes: appetite suppressants and absorption inhibitors. Bariatric surgery is an option for patients with the metabolic syndrome who have a body mass index (BMI) >40 kg/m2 or >35 kg/m2 with comorbidities. Gastric bypass results in a dramatic weight reduction and improvement in the features of metabolic syndrome. A survival benefit has also been realized.

LDL Cholesterol

For patients with the metabolic syndrome without diabetes, the Framingham risk score may predict a 10-year CVD risk that exceeds 20%. In these subjects, LDL cholesterol should also be reduced to <100 mg/dL. With a 10-year risk of <20%, however, the targeted LDL cholesterol goal is <130 mg/dL. Also refer to the newly instituted ASCVD calculator!





A fasting triglyceride value of <150 mg/dL is recommended. In general, the response of fasting triglycerides relates to the amount of weight reduction achieved. A weight reduction of >10% is necessary to lower fasting triglycerides.

++A fibrate (gemfibrozil or fenofibrate) is the drug of choice to lower fasting triglycerides and typically achieve a 35–50% reduction.

++Other drugs that lower triglycerides include statins, nicotinic acid, and high doses of omega-3 fatty acids.


HDL Cholesterol


Beyond weight reduction, there are very few lipid-modifying compounds that increase HDL cholesterol. Nicotinic acid is the only currently available drug with predictable HDL cholesterol-raising properties. The response is dose-related and can increase HDL cholesterol ~30% above baseline.


Blood Pressure


The direct relationship between blood pressure and all-cause mortality rate has been well established, including patients with hypertension (>140/90) versus prehypertension (>120/80 but <140/90) versus individuals with normal blood pressure (<120/80). In patients with the metabolic syndrome without diabetes, the best choice for the first antihypertensive should usually be an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker, as these two classes of drugs appear to reduce the incidence of new-onset Type 2 diabetes. In all patients with hypertension, a sodium-restricted diet enriched in fruits and vegetables and low-fat dairy products should be advocated. Home monitoring of blood pressure may assist in maintaining good blood pressure control.


Impaired Fasting Glucose


In patients with the metabolic syndrome and Type 2 diabetes, aggressive glycemic control may favorably modify fasting triglycerides and/or HDL cholesterol. Metformin has also been shown to reduce the incidence of diabetes, although the effect was less than that seen with lifestyle intervention.


Insulin Resistance


Several drug classes [biguanides, thiazolidinediones (TZDs)] increase insulin sensitivity. Because insulin resistance is the primary pathophysiologic mechanism for the metabolic syndrome, representative drugs in these classes reduce its prevalence.


So do you think you/someone you know may have the metabolic syndrome? If so, contact your primary care doctor/cardiologist/your friendly neighborhood endocrinologist!!



1)      Metabolic Syndrome and Incident Diabetes: Diabetes Care. 2008 Sep; 31(9): 1898–1904.

2)      The Metabolic Syndrome: Harrison’s Endocrinology 3rd edition 2013 Chapter 18 253-260.