The major risk factor associated with cardiovascular disease is metabolic syndrome. Approximately 50 million Americans are estimated to have this syndrome. The metabolic syndrome involves a cluster of metabolic abnormalities. Various national organizations, such as the American Heart Association and National Heart, Lung, and Blood Institute, have recommended that in order to diagnose metabolic syndrome, three of the following criteria should be met:

1. Waist Circumference:
Men--greater than 102 cm
Women--greater than 88cm
2. Triglycerides:
greater than 150
3. HDL:
Men--less than 40
Women--less than 50
4. Blood Pressure:
greater than or equal to 130/85
5. Fasting Blood Sugar:
greater than or equal to 100

Note: In Asian populations (except Japanese), the waist circumference criteria is Men greater than 90cm and Women greater than 80cm.

The recommended treatment is to:
1. Lose weight, with a target BMI of less than 25
2. Increase physical activity to 30 minutes per day
3. Develop healthy eating habits

One of the known ways to achieve a healthy lifestyle to reduce oxidative stress is to practice the techniques of yoga. Yoga is an ancient mind and body discipline that has been practiced in India for more than 4,000 years. It has been used in the United States during the past several decades. Among the many forms of yoga being taught are Hatha Yoga, Raja Yoga and many others. Sometimes included in this category are meditation techniques, such as Transcendental Meditation and Vipassana. The various forms exist to fit each person's physical ability and preference. Almost everyone can practice one form of yoga irrespective of their age or physical condition.

Yoga is known to positively influence the risk profile of cardiovascular disease. It is a noninvasive practice, which is economical and can be practiced by any individual at his or her own convenience. Yoga induces a relaxation response, which is associated with reduced nervous system activity and a feeling of well-being due to an increase in antioxidant levels and a decrease in cortisol levels.

In looking for evidence-based studies, I found a number of studies conducted in India, Europe and the United States, which have shown the benefit of yoga in improving the cardiovascular risk profile. In one report, Kim Ines and her associates identified 70 studies that assessed the effect of yoga on cardiovascular risk factors. The duration of treatment varied from one session to 12 months.

The changes were:
1. Reduced blood sugar of 5.4-6.4 percent for adults with hypertension; 25.1-33.4 percent for adults with Type-2 DM
2. Reduced post-prandial blood sugar of 24.5-27 percent for adults with Type-2 DM
3. Reduced HbA1C of 13.3-27.3 percent for adults with Type-2 DM
4. Reduced cholesterol of 5.8-10.1 percent for adults with HTN, CVD, and Type-2 DM
5. Reduced LDL of 26 percent for adults with HTN, CVD, and Type-2 DM
6. Reduced systolic BP of 7.1-17 percent for adults with risk of CVD
7. Reduced diastolic BP of 8.5-16.7 percent for adults with risk of CVD
8. Reduced heart rate of 14.9 percent for adults with chronic DZ

In conclusion, the metabolic syndrome is a serious health concern for our population. The ancient technique of yoga can have a significant positive effect on this syndrome and hence help reduce cardiovascular morbidity and mortality in the United States Even in remote areas, it can be easily learned and incorporated into one's daily routines. As physicians, we can also take an active role in suggesting this non-invasive, inexpensive, pleasurable modality to our patients. Not only will they benefit physically, but mentally and emotionally, as well.