Profile of Metabolic Syndrome at CNHU HKM Cotonou

The metabolic syndrome combines morphological, physiological and biochemical abnormalities that evolve over time, predisposing the affected person to atherosclerosis and its complications. The purpose of our work was to determine the clinical and biological profile of metabolic syndrome in patients received for medical examination according to WHO criteria. This was a retrospective study over a 1-year period: from January 1st, 2018 to December 31st, 2018. The information collected was clinical (sociodemographic charac-teristics, anthropometric data, initial blood pressure, cardiovascular history) and biological data (fasting blood glucose level, lipid test). Two thousand six hundred and two patients visited during the study period, including 291 patients (11.18%) for a reason that may evoke the metabolic syndrome but 115 files were retained for this study. The age of the patients was 58.39 ± 10.02 years with extremes ranging from 32 to 81 years old. Metabolic syndrome was found in 77 patients, or 66.9% of patients who had consulted for a reason that might suggest this diagnosis. 44.3% had 3 criteria for definition; 19.1% had 4 criteria and 3.5% had 5 criteria. All patients have benefited a mono, bi or antihypertensive therapy associated with antidiabetic or hypolipemic treatment. Metabolic syndrome better predicts cardiovascular risk than analysis of individual risk factors. Its prevention involves diet which must be hyposodium, hypolipidic, without fast sugar and daily physical activities.

Gerald M. Reaven around insulin resistance was the first well-structured version of the metabolic syndrome in 1988 [3]. Due to the increase in the prevalence of obesity over the last decade, five definitions have been proposed by several groups to characterize the metabolic syndrome. It was recognized by the World Health Organization (WHO) in 1998 [4]. Metabolic syndrome combines morphological, physiological and biochemical abnormalities that evolve with time predisposing the affected subject to atherosclerosis and its complications. The prevalence of metabolic syndrome among hypertensive patients in Parakou was 69.6% according to the criteria of the International Diabetes Federation (IDF) and 65.2% according to those of the National Cholesterol Education Program (NCEP) [5]. It was 79% among obese patients in Ouidah according to WHO criteria [6].
The purpose of our work was to determine the clinical and biological profile of metabolic syndrome in patients received for medical examination according to WHO criteria.

Methodology
This was a retrospective study over a 1-year period: from January 1st, 2018 to December 31st, 2018, involving patients who had consulted in endocrinology and cardiology units. A systematic review of medical records was completed. The information collected was clinical (sociodemographic characteristics, anthropometric data, initial blood pressure, cardiovascular history) and biological data (fasting blood glucose level, lipid test). Were considered diabetic patients already known and treated as such or whose fasting blood glucose level was greater than or equal to 1.26 g/l. The dyslipidemia was held in front of a total cholesterol level higher than 2.5 g/l or a LDL cholesterol level higher than 1.15 g/l. The LDL-cholesterol level was obtained from Friedwald's formula by reporting the difference between total cholesterol and HDL-cholesterol at 1/5th of triglyceridemia (in grams per liter).
WHO's criteria were used for the determination of the metabolic syndrom. These criteria include visceral or central obesity, waist/hip circumference > 0.9 (male) and 0.75 (female) and/or BMI > 30 kg/m 2 . Records in which metabolic syndrome assessment parameters are completed, we chose BMI which was systematically estimated at our patients, associated with at least 2 of the following criteria: -Blood glucose > 1 g/l; -Blood pressure ≥ 140 mmHg; -Triglyceride ≥ 1.50 g/l; -HDL-Cholesterol (HDL-c) < 0.35 g/l in men and < 0.39 g/l in women.
The inclusion criteria were the records containing the above-mentioned parameters. We evaluated the effectiveness of treatment instituted with a follow-up

Results
Two thousand six hundred and two patients consulted during the study period, including 291 patients (11.18%) for a reason that could evoke the metabolic syndrome. One hundred and fifteen records were usable in this study. Among the 115 cases there were 77 cases (2.9%) of metabolic syndrome.
The population consisted of 115 patients with as many men as women. The age of the patients was 58.39 ± 10.02 years with extremes ranging from 32 to 81 years ( Metabolic syndrome was found in 77 patients (66.9%) who are distributed according to WHO criteria in Figure 1 and 44.3% had 3 criteria for definition; 19.1% had 4 criteria and 3.5% had 5 criteria. All patients have benefited a mono, bi-or antihypertensive therapy associated with antidiabetic or hypolipemic treatment. Evaluation of the patients at 6 months allowed to evaluate the prescribed treatment ( Table 2 and Table 3

Discussion
We conducted a retrospective hospital-based study, which constitutes a recruitment bias in the assessment of prevalence. The retrospective nature of the study did not systematically provide all the information needed to make a diagnosis of  metabolic syndrome. Prevalence 2.9% is lower than the hospital prevalence of 4.94% observed in Cote d'Ivoire [7]. And 17.5% in Burkina faso in patients hospitalized for high blood pressure [8]. Prevalence is 8.9% in the general population in Senegal [9] and ranges from 6.1% in women to 10.2% in men in France [10]. This variation may be a reflection of the different socio-economic conditions in the countries, or related to the diet and the change of lifestyle of the different populations but also the difficulty of harmonizing the definition criteria.  [11]. Similarly, blood glucose and triglycerides were on average higher and HDL cholesterol was on average lower than in the general population [11]. The most common risk factors were high blood pressure followed by obesity 77.4%, low HDL cholesterol 59.1% and diabetes 39.1%. In most studies, low HDL cholesterol was more common [7] [11] [12], which may reflect a lack of physical activity. The prevention of this factor is then important in the management of the metabolic syndrome.

Conclusion
Metabolic syndrome is a pathology that poses the problem on the one hand of its non-consensual definition and on the other hand that of the control of its constituent elements, especially high blood pressure. Metabolic syndrome better predicts cardiovascular risk than analysis of individual risk factors. Its prevention involves diet which must be hyposodium, hypolipidic, without fast sugar and daily physical activities.