High blood sugar ,High blood pressure ,high blood lipids,high uric acid ,"four highs" problems are one of the most common health problems faced by modern people.
Blessings come unparalleled, but misfortunes never come in singular ways. Members of the "Four Highs" rarely "do commit crimes alone" and often "gang operations". Being targeted by one of them, the remaining three often follow. Among the patients with diabetes and , hypertension, hyperlipidemia, and hyperuric acid are also extremely common comorbidities.
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Why do the "four highs" always come together in groups?
Speaking of this issue, we need to start with a concept -
that is "metabolic syndrome" .
What is "metabolic syndrome"?
As early as the 1980s, some doctors noticed that many patients often suffer from hypertension, hyperglycemia and blood lipid disorders at the same time, and most patients also have the problem of "central obesity" .
As this issue resonates with more and more clinicians, it also brings more and more attention. In 1988, for the first time, a scholar proposed the concept of "X syndrome" to describe a collection of endocrine and metabolic disorders including hypertension, obesity, blood lipid disorders and insulin resistance. The concept of "X syndrome" gradually evolved into the later "metabolic syndrome".
In 1995, Stern, a well-known scholar in the endocrine and metabolic academic field, proposed the famous theory of "common soil". This theory believes that insulin resistance (IR) is the common soil for urging diabetes, hypertension, and cardiovascular system diseases. This is also a theory generally accepted in the field of diabetes, that is, insulin resistance is the precursor of diabetes. We will explain this in more detail below.
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As the popularity of the field of "metabolic syndrome" is getting higher and higher, large public health institutions such as the World Health Organization (WHO), International Diabetes Alliance (IDF) have also made specific definitions of "metabolic syndrome".
has different definitions, but basically all tissues and institutions are concentrated on hypertension, glucose tolerance is damaged or fasting blood sugar is damaged , blood lipid disorder and central obesity, which are the hypertension, hyperglycemia, and hyperlipidemia that have been repeatedly mentioned in the past decade - the "three highs" .
As the living standards of human society further improve in recent years, the prevalence of hyperuricemia, gout and other problems has also increased year by year, and the threat to human health is becoming increasingly serious. Some new institutions and organizations have also tried to include hyperuricemia in the consideration of "metabolic syndrome", and the endocrine field has gradually expanded the scope of "three highs" to "four highs".
Therefore, "metabolic syndrome" can be considered a collection of problems such as central obesity, hypertension, hyperlipidemia, and hyperuric acid based on insulin resistance.
How does "metabolic syndrome" occur? What makes the "Four Highs" rush forward?
Ahead we mentioned the famous "common soil" theory, which is also one of the more recognized theories in the field of modern cutting-edge endocrine and metabolism. The core view of the theory of
is that the higher free fatty acid levels in the blood of obese people, especially central obese people, will trigger muscles and tissues to resist insulin , and the reduced effect of insulin will lead to accelerated decomposition of adipose tissue and produce more free fatty acids. In this way, a vicious cycle will be formed. In addition to directly manifesting as dyslipidemia , free fatty acids that continue to increase in
will also produce lipotoxicity to organs including pancreatic islets, activate a series of downstream pathways, induce inflammatory responses, and damage various organs.
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In addition to the well-known lowering of blood sugar, insulin also has a regulatory effect on the reabsorption of vascular smooth muscle and renal tubular .While insulin relaxes the vasculature (the tendency to lower blood pressure), it enhances the reabsorption of sodium (the tendency to increase blood pressure). However, studies have shown that in Asian and African populations, the effect on vasodilation disappears when insulin resistance exists, but retains the reabsorption and promotion of sodium, which is one of the important mechanisms known to cause hypertension by insulin resistance.
In addition, hyperinsulinemia , which is accompanied by insulin resistance, has also been successively confirmed to enhance the reabsorption of uric acid in the urine by the renal tubules, so that more uric acid cannot be excreted with the urine and returned to the blood; and vascular endothelial damage caused by hypertension and dyslipidemia will also increase the production of uric acid, so it is not surprising that uric acid increases.
things still don't end here. Problems such as hypertension, hyperuricemia, and abnormal sugar metabolism caused by insulin resistance will in turn further strengthen insulin resistance, leading to more serious metabolic syndromes. It can be said that they are mutually causal and complement each other.
From this perspective, it seems very reasonable that the "Four Highs" commit crimes in groups and appear in groups.
Since it is so serious, why don’t doctors mention “metabolic syndrome” now?
As the concept of "metabolic syndrome" spreads more and more widely, there are also many doubts.
On the one hand, many people believe that as a collection of multiple signs, the diagnostic and evaluation standards are very inconsistent, and even between authoritative institutions and organizations, there are certain differences. From a public health perspective, this is not conducive to the elimination and diagnosis and treatment of diseases.
On the other hand, the proposed metabolic syndrome is to make everyone pay more attention to the organic connection between these symptoms and the cardiovascular risks it brings. Some diseases included in metabolic syndrome have been confirmed to have a strong correlation with cardiovascular risk and therefore cannot be regarded as an independent disease.
Therefore, the concept of metabolic syndrome has been proposed, which has widely promoted the intersection and extension of disciplines such as endocrine and metabolicism, cardiovascular disease, and nephrology. It has also promoted the popularization of the multidisciplinary concept of diabetes and cardiovascular disease. It is great to achieve this mission, and there is no need to set up a special diagnosis and treatment plan for this.
References
[1]Eckel R H, Grundy S M, Zimmet P Z. The metabolic syndrome[J]. The lancet, 2005, 365(9468): 1415-1428.
[2]Borch-Johnsen K, Wareham N. The rise and fall of the metabolic syndrome[J]. Diabetologia, 2010, 53(4): 597-599.
[3]Kahn R. American Diabetes Association; European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes[J]. Diabetes Care, 2005, 28: 2289-2304.
[4]Hu Bin, Zhou Yujie. Research progress on the pathogenesis of metabolic syndrome [J]. Chinese Journal of Cardiovascular and Cerebrovascular Disease in the Elderly, 2012, 14(3): 328-329.
Editor author
Author: Bo Yi
Editor: Bo Yi
Editor: Bo Yi
