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History and General Examination 25
‘apple-shaped’ configuration with a greater waist-
hip ratio have an increased risk of atherosclerotic
cardiovascular diseases (Fig. 12).
Waist circumference should be measured at a level
midway between the lower rib margin and iliac crest
with the tape all around the body in horizontal position.
Hip circumference should be measured over the buttocks
at the region of maximal circumference.
Fig. 12: Calculation of waist-hip ratio
38. How do you define the metabolic syndrome?
The metabolic syndrome has been recognized as a
proinflammatory, prothrombotic state, associated with
elevated levels of C-reactive protein, interleukin-6 and
plasminogen activator inhibitor-1. These inflammatory
and prothrombotic markers are associated with an
increased risk for subsequent cardiovascular disease
and type 2 diabetes. Current ATP III criteria define the
metabolic syndrome as the presence of any three of the
following five traits:
