People don't develop type 2 diabetes or drop dead from a heart attack out of the blue. There's usually a hint that trouble is brewing.

An estimated 50 million Americans exhibit a cluster of risk factors - traits, conditions or habits - that boost their chances of developing heart disease and diabetes, according to the American Heart Association. Collectively, these risk factors are dubbed "metabolic syndrome." But chances are your doctor won't use that term.

Dr. Pauline Leong, an attending physician at North Shore University Hospital in Manhasset, said she tends to use "prediabetic" instead because patients understand it better.


SYMPTOMS

A spare tire around the waist is a visible sign that you're in the danger zone, cautions the U.S. National Heart, Lung and Blood Institute. Thirst, urination, fatigue and blurred vision may signal excess blood sugar, it says.

But if you have high blood pressure, you may not have any symptoms.


RISK FACTORS

Experts don't agree on exactly how to define metabolic syndrome. Generally, though, the risk factors include:

* Elevated blood pressure

* A higher-than-normal fasting blood sugar (tested when you have not eaten for eight hours)

* High triglycerides, a type of fat found in the blood

* Lower-than-normal high-density lipoprotein, or HDL, the good type of cholesterol

* Excess belly fat

A person who has three or more of these is generally considered to have metabolic syndrome. And as the number of risk factors increases, so does the likelihood of problems. Someone with metabolic syndrome, according to government data, is twice as likely to develop heart disease as is a person who doesn't have the syndrome. The risk for diabetes is five times greater for someone with metabolic syndrome.


CURRENT THINKING

Although the exact cause is not known, scientists believe that insulin resistance plays a role in the development of metabolic syndrome, reports the International Diabetes Federation. Someone who is insulin-resistant cannot efficiently convert blood sugar into energy. This leaves excess sugar in the blood, which can lead to type 2 diabetes and cause damage to the heart and blood vessels.

A doctor might prescribe medicines to fight unhealthy blood pressure, cholesterol and blood sugar. But, first and foremost, people are urged to quit smoking, drop excess weight, engage in regular physical activity and follow a high-fiber, low-salt diet loaded with fruits, vegetables and grains.

"I try not to use medications until I can assure that they understand that lifestyle modification is priority," Leong said. "If you don't recognize that, then if all I do is prescribe medications to you, then undoubtedly your weight stays the same, you're still sedentary and you're eating the wrong foods."


THE LONG ISLAND SCENE

Winthrop-University Hospital in Mineola offers Lifestyle Balance, a pre-diabetes program that teaches people to plan heart-healthy meals and fit exercise into their daily routine.


Who's who

This is the fourth installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: internists


INTERNISTS

Dr. Michael Ammazzalorso

222 Station Plaza N., Suite 310, Winthrop Int. Med. Assocs., Mineola, 516-663-2051

Dr. Barry Balot

150 E. Sunrise Hwy., Lindenhurst, 631-225-6200

Dr. Nicholas Berbari

222 Station Plaza N., Suite 310, Winthrop Int. Med. Assocs., Mineola, 516-663-2051

Dr. Jeffrey Berger

222 Station Plaza N., Suite 518, Mineola, 516-663-2588

Dr. Robert Bernard

6144 Rte. 25-A, C Bldg., Suite 10, Wading River, 631-929-5900

Dr. Mark Corapi

222 Station Plaza N., Suite 310, Mineola, 516-663-2051

Dr. Alexander Covey

445 Main St., Center Moriches, 631-878-9200

Dr. Stephen Cusumano

850 Hicksville Rd., Suite 110, Seaford, 516-735-5454

Dr. Michael Delman

301 E. Main St., Bay Shore, 631-968-3322

Dr. Richard Federbush

175 Jericho Tpke., Suite 216, Syosset, 516-364-9800

Dr. Cornelius Foley

Medical Dept., 271-11 76th Ave., New Hyde Park, 718-289-2277

Dr. Steven Friedling

267 E. Main St., A Bldg., Smithtown, 631-724-8348

Dr. Burt Gelberg

401 Franklin Ave., Franklin Square, 516-326-2255

Dr. Harold German

150 Main St., Huntington, 631-271-8700

Dr. Steven Goldfarb

365 County Rd., 39-A, Suite 12, Southampton, 631-283-5542

Dr. Michael Goodman

2495 Newbridge Rd., Bellmore, 516-826-1200

Dr. Lydia Gorski

820 Jericho Tpke., New Hyde Park, 516-352-0430

Dr. Joanne Gottridge

865 Northern Blvd., Suite 102, Great Neck, 516-622-5001

Dr. Edward Hallal

180 E. Main St., Bay Shore, 631-665-0027

Dr. Edward Hotchkiss

158 Hempstead Ave., Lynbrook, 516-593-3541

Dr. Corradino Lalli

363 Route 111, Suite 106, Smithtown, 631-366-0404

Dr. Pauline Leong

865 Northern Blvd., Suite 102, Great Neck, 516-622-5000

Dr. John Oppenheimer

60 Bay St., Sag Harbor, 631-725-4600

Dr. Harvey Pollak

2800 Marcus Ave., Suite 102, Lake Success, 516-622-6040

Dr. Frederic Rakowitz

295 Northern Blvd., Suite 208, Great Neck, 516-482-4940

Dr. Rosario Romano

5225-15 Rte. 347, Port Jefferson Station, 631-331-1000

Dr. Jack Rubenstein

70 Glen Cove Rd., Suite 301, Roslyn Heights, 516-621-1502

Dr. Steve Rucker

1999 Marcus Ave., Lake Success, 516-775-4545

Dr. Lloyd Simon

44210C County Rd. 48, Box 1341, Southold, 631-765-4150

Dr. Lowell Taubman

206 Riverside Blvd., Long Beach, 516-432-5670

Dr. Leonard Timpone

1051 Adams Ave., Franklin Square, 516-354-4858

Dr. Mark Weinstein

4045 Hempstead Tpke., Floor 3, Bethpage, 516-731-7770


How they were chosen

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.


To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.

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