The prevalence of metabolic syndrome in children is on the rise. One out of eight children, ages 8 to 17, has been identified as having metabolic syndrome, placing them at greater risk for premature heart disease and diabetes

The average yearly pharmacy cost of treating adult patients over age 20 with metabolic syndrome exceeds $4,000 -- more than four times the average annual drug spend for all other patients, according to data released by Medco Health Solutions, Inc. The analysis also found that the number of adults being treated for the conditions associated with metabolic syndrome increased more than 36 percent from 2002 to 2004.

"Metabolic syndrome and its components -- diabetes and pre-diabetes, obesity, hypertension and abnormal lipids -- will likely become the major public health problems we face in the 21st century," said Dr. David M. Nathan, professor of medicine at Harvard Medical School and director of the Diabetes Center at Massachusetts General Hospital.

"Its long-term consequences, including heart disease, stroke, and the other complications of diabetes, can be reduced with aggressive treatment of risk factors, but at a substantial cost. Lifestyle approaches should also decrease metabolic syndrome and its long-term health and economic costs," he added.

Identifying Risk Factors

Patients with metabolic syndrome have three or more of these risk factors:

They are at a 3.5 times greater risk of death from coronary heart disease, as well as an increased risk of liver and kidney disease, and possibly cancer.

Metabolic syndrome is closely associated with a generalized metabolic disorder in which the body is unable to use insulin efficiently. Although some people are genetically disposed, others can develop the syndrome due to excess body fat and physical inactivity.

Non-drug treatments for metabolic syndrome include weight loss, dietary changes and increased physical activity. One recently published study from the University of Pittsburgh found that a program involving weight loss and exercise decreased the incidence of metabolic syndrome by almost 41 percent as compared to the control group, while the incidence rate among patients on drug therapy was reduced by only 17 percent.

"The cornerstones of treatment for metabolic syndrome and the prevention of diabetes are better dietary and exercise habits," said Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

$4 Out of Every $10 Spent on Rx

Medco's analysis reviewed prescription drug data for approximately 2 million adult patients aged 20 years or older. Those categorized with metabolic syndrome were taking medications for at least three of the risk factors associated with it -- diabetes, abnormal cholesterol and hypertension.

Due to the low prevalence of people on weight loss prescription medications, obesity was not calculated into the cost of metabolic syndrome, but it is a major contributor to the prevalence of this condition.

Among the major findings of the analysis:

Physician Alert System

In response to the growing prevalence of metabolic syndrome, and the costs associated with the condition, Medco announced that it will launch the nation's first physician alert system that will use integrated claims data to identify those patients that have, or are at risk of developing, metabolic syndrome.

Medco's system will cross-reference pharmacy claims data with laboratory and medical claims data to identify these patients.

Once at-risk patients are identified, Medco will send an alert package to the prescribing physician and the patient providing them with information and recommendations for changes in therapy and/or lifestyle.

Metabolic syndrome patients are, on average, receiving prescriptions for medications from five different physicians; 25 percent are seeing seven different prescribing doctors, said Dr. Robert Epstein, Medco's chief medical officer, citing Medco data. These physicians might not always be aware of the myriad conditions affecting the patient, he noted.

"Our prescription data allows us to track patients using medications for two or more of the metabolic syndrome risk factors, identifying them as either at risk for, or afflicted with, metabolic syndrome -- information that can assist physicians in making the most appropriate treatment choices for their patients," Dr. Epstein explained.

The Next Epidemic?

Metabolic syndrome affects nearly 50 million Americans -- almost one in four American adults. Approximately 7 percent of adults in their 20s and about 40 percent of adults over age 40 meet the criteria for the syndrome. The prevalence in Americans over age 40 has increased by more than 60 percent in the past decade, Medco pointed out.

Although no clinical guidelines for the treatment of metabolic syndrome in children currently exist, the prevalence of this condition in children is on the rise. One out of eight children, ages 8 to 17, has been identified as having metabolic syndrome, placing them at greater risk for premature heart disease and diabetes, Medco noted.

The most common risk factors among this age group are abnormal cholesterol levels and excessive weight; 32 percent of overweight children develop metabolic syndrome. Adolescent boys are more likely to become afflicted with the syndrome than adolescent girls, the company said.

More aggressive treatment of metabolic syndrome could increase dramatically the utilization of medications to treat the underlying conditions, and this growth could accelerate if treatment is extended to the pediatric population.

For medications that address multiple underlying conditions, manufacturers eventually may seek an indication for the treatment of metabolic syndrome. Two diabetes drug classes, the thiazolidinediones and alpha-glucosidase inhibitors, are possible initial candidates for this indication, said Medco.