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Know the early warning signs of metabolic syndrome—a growing problem

Patients who have metabolic syndrome are at higher risk of multiple chronic conditions, including diabetes, coronary heart disease, and cancer, as well as stroke. Metabolic syndrome has become increasingly common: its prevalence has risen in every sociodemographic group, and today it is estimated that more than a third of adults in the United States have metabolic risk.1

Some factors contributing to metabolic syndrome are genetic, while others can be modified with lifestyle changes. Quest Diagnostics offers a full range of Cardio IQ® testing options to help evaluate patients’ metabolic and cardiovascular risk so physicians can take action to help prevent or delay onset of chronic conditions, and prevent adverse events such as stroke.

Diabetes Risk Panel with Score and Diabetes and ASCVD Risk Panel with Scores

Diabetes Risk Panel with Score measures glucose, hemoglobin A1c (HbA1c), and lipids. It also estimates the 8-year risk of developing diabetes using laboratory test results, anthropomorphic data, and family history. The risk algorithm is based on the analysis of 3,453 individuals (ages 30⎻79) within the Framingham cohort. It is intended to aid in the identification of patients at risk for developing diabetes mellitus, permitting lifestyle or pharmacologic interventions.

The Diabetes and ASCVD Risk Panel with Scores provides an 8-year risk of developing diabetes as well as 10-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk scores, also calculated. This panel is useful for monitoring diabetic complications.

Omega-3 and omega-6 testing

A diet rich in omega-3 fatty acids is associated with a decreased risk of cardiovascular events, including sudden cardiac death (SCD). The three major omega-3 fatty acids are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid. Omega-6 fatty acids are proinflammatory and prothrombotic. The most abundant forms of omega-6 fatty acids are arachidonic acid (AA) and linoleic acid (LA). The omega-3 index, EPA and DHA expressed as a percentage of phospholipid FAs, is an indicator of risk for SCD and nonfatal cardiovascular events and as a therapeutic target. The EPA/AA ratio is a marker of cardiovascular risk, with higher ratios being associated with lower cardiac risk.

Quest offers two options for omega-3 and omega-6 fatty acid testing:

  • Omega-3 and Omega-6 Fatty Acids (FAs) 91734(X) measures EPA, DHA, alpha-linolenic acid, and AA levels free in serum.
  • OmegaCheck™ 92701(X) measures EPA, docosapentaenoic acid (DPA), DHA, and AA and LA levels in whole blood.

TMAO, available only from Quest and our Cleveland HeartLab Center of Excellence

A novel marker, trimethylamine-N-oxide (TMAO), is a metabolite produced by the gut microbiome following consumption of food products containing the precursors L-carnitine, choline, and phosphatidylcholine (lecithin), which are abundant in various animal-derived products (dairy, egg yolk, and red meat) as well as dietary supplements and energy drinks. TMAO impacts physiological processes that may increase risk of atherosclerosis, enhance platelet hyperreactivity, and increase thrombosis. Elevated TMAO is associated with a 2.5x increased risk of incident major adverse cardiovascular events (MACE). A meta-analysis also demonstrated a 7.6% increase in relative risk for CVD mortality for every 10 μmol/L increase in TMAO.

Vitamin D, 25 Hydroxy, LC/MS/MS

Low levels of Vitamin D, 25 Hydroxy are associated with increased risk of CVD events and death due to heart failure, sudden cardiac death, and stroke. The cardiovascular impact of low vitamin D is through activation of the renin-angiotensin-aldosterone system, as well as through increased parathyroid hormone levels (which predispose individuals to increased insulin resistance associated with diabetes, hypertension, inflammation, and increased cardiovascular risk).

Vitamin D, 25 Hydroxy is the main form of vitamin D circulating in blood and the best indicator of vitamin D deficiency or excess. Vitamin D tests using liquid chromatography, tandem mass spectrometry (LC/MS/MS) may also provide the concentration of vitamin D2 and D3 which, when added together, equal the total vitamin D concentration.

Metabolic testing from Quest Diagnostics

Quest offers a full complement of tests, from routine to advanced, to help you obtain the most complete picture possible of your patient’s risk of metabolic syndrome.

Cardio IQ® metabolic testing from Quest

Test Name Clinical utility
Diabetes Risk Panel with Score

Diagnosis of prediabetes

Helps assess risk for developing type 2 diabetes mellitus

Helps identify patients suitable for lifestyle interventions and/or pharmacotherapy

Diabetes and ASCVD Risk Panel with scores

Diagnosis of prediabetes

Helps assess risk for developing type 2 diabetes mellitus and cardiovascular disease

Helps identify patients suitable for lifestyle interventions and/or pharmacotherapy


Measures serum glucose levels under fasting conditions

Elevated serum glucose (hyperglycemia) is associated with diabetes and insulin resistance

Low levels indicate hypoglycemia

Hemoglobin A1c

Reflects average blood sugar levels over the preceding 90-day period

Elevated levels are associated with prediabetes and diabetes

Requires no fasting or glucose loading requirement

Less sensitive than glucose to stress and illness

More specific for identifying individuals at increased risk for diabetes


Associated with the characterization of an atherogenic lipid profile and metabolic syndrome

Especially when combined with other risk factors, identifies patients at significantly higher risk for the development of CVD


Helps assess increased risk of incident MACE

Helps assess increased relative risk for CVD mortality

Omega-3 and Omega-6 Fatty Acids

Helps determine fatty acid-associated risk for cardiovascular events

Screens for omega-3 fatty acid deficiency

Monitors omega-3 fatty acid intake (diet, overthe-counter supplements, prescription medication)

OmegaCheck May be performed on individuals with hypercholesterolemia, hypertriglyceridemia, hypertension, and/or those with high metabolic or cardiovascular risk
Vitamin D, 25 Hydroxy, LC/MS/MS Helps assess risk of CVD events and death due to heart failure, sudden cardiac death, and stroke

For individuals at high risk of CVD due to family history of premature disease, high or very high levels suggest an increased risk of developing a cardiovascular event

For individuals with pre-existing CVD, elevated levels suggest an increased risk of disease progression


  1. Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis. 2017;14:160287.

This information is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

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