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exercise as well as managing other comorbid conditions.
     
    Patients diagnosed with metabolic syndrome also typically form blood clots and present with constant low-grade inflammation throughout the body. Additional conditions that have been associated with metabolic syndrome include fatty liver, polycystic ovary syndrome, gallstones, and sleep apnea.
     

Symptoms
    The symptoms of metabolic syndrome present as a combination of other conditions. Therefore, the symptoms of metabolic syndrome are based on underlying conditions that define the condition such as hypertension, diabetes, or high cholesterol.
     
    Other comorbid conditions associated with metabolic syndrome include elevated uric acid levels, fatty liver disease, polycystic ovary syndrome, hemochromatosis, and acanthosis nigricans.
     

Screening and diagnosis
    Physical examination and diagnostic tools are used to diagnose metabolic syndrome. Patients with 3 or more of the following risk factors including abdominal obesity, higher than normal triglyceride levels, higher than normal high-density lipid cholesterol levels, hypertension, and hyperglycemia are diagnosed with metabolic syndrome. Patients with 1 or more than the above symptoms should seek medical attention to prevent other complications or comorbid conditions.
     
    Patients with type II diabetes should be screened for metabolic syndrome as more than 80% of type II diabetes patients have comorbid metabolic syndrome and are at a higher risk for cardiovascular disease.
     

Endothelial dysfunction
     
    Endothelial dysfunction is defined as abnormal functioning of the cells forming the endothelium, the innermost lining of blood vessels. It is characterized by reduced vasodilation, increased proinflammatory response and prothrombotic properties.
     
    Patients with endothelial dysfunction typically present with an inability of arteries and veins to dilate properly or fully. Biochemical dysfunction of the endothelium leads to problems with coagulation, platelet adhesion, immune function and electrolyte balance.
     
    Individuals diagnosed with endothelial dysfunction are at a higher risk for developing cardiovascular disease as well as having a heart attack or stroke due to presence of atherosclerosis. They are also at risk for developing the following comorbid complications, if not already present, including congestive heart failure, chronic renal failure, peripheral artery disease, and diabetes. The prognosis of endothelial dysfunction is dependent on the degree and extent of the disease as well as presence of other comorbid conditions.
     
    Physical examination and comorbid conditions suggest the condition and diagnostic tools can be used to diagnose endothelial dysfunction. Patients with elevated risk for the disease including those with diabetes and other cardiovascular risk factors should be screened for the condition.
     
    Diagnostic screening for endothelial dysfunction can be determined using the following methods: iontophoresis of acetylcholine, intraarterial administration of vasoactive agents, localized heating of the skin and temporary arterial occlusion via inflating a blood pressure cuff to high pressures. Another more invasive approach is intracoronary catheterization, but it is not often performed due to increased risk of complications.
     

Hypertension
     
    Hypertension is defined as high blood pressure chronically elevated at greater than or equal to 140/90 mmHg. Hypertension can be classified as primary hypertension or as result of a comorbid condition and referred to as secondary hypertension. Secondary hypertension can be attributed to kidney disease, metabolic disorders, or cancer. Primary hypertension occurs in 90% to 95% of individuals diagnosed with high blood pressure, as compared to secondary hypertension, which occurs in 2% to 10%.
     
    The incidence and prevalence of hypertension increase with natural aging. In the United States, more than 40 million individuals have been estimated to