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I have been diagnosed with metabolic syndrome and was told that it can affect my heart health as much as smoking two packs of cigarettes a day can. What does metabolic syndrome have to do with heart disease?

Metabolic syndrome is a cluster of conditions — high blood pressure, excess fat around the waist (apple-shaped body), low levels of HDL cholesterol (the "good" cholesterol) and high levels of blood sugar and the blood fat called triglycerides — that occur together.

Having just one of these factors increases your risk of heart disease because it will promote hardening of the arteries (atherosclerosis) and the formation of blood clots, both of which contribute to heart attacks. With a combination of factors, your risk is even greater. One study showed that men with three or more metabolic-syndrome components are nearly twice as likely to have a heart attack or stroke, and more than three times as likely to develop heart disease as are those without any factors.

Underlying practically all of the components of metabolic syndrome is "insulin resistance," a condition in which the muscle cells need excessive amounts of insulin to process blood sugar for energy. The resulting elevated levels of insulin and glucose in the blood interfere with the body's metabolic processes — raising the levels of triglycerides and other blood fats, for example — and they affect kidney function, leading to increased blood pressure.

Insulin resistance also contributes to narrowing of the coronary arteries, which reduces blood flow; to thickening of the blood, which makes it easier to get blood clots; and to high levels of blood markers of inflammation, which have been linked to an increased risk of heart attack.

The cornerstone of treatment for metabolic syndrome is exercise and diet. For example, getting 30 to 60 minutes of moderate-intensity exercise, such as brisk walking, every day and losing as little as 5 percent to 10 percent of your body weight can pay significant dividends in reducing insulin levels, blood pressure and blood sugar. Such lifestyle changes are important for everyone, but they are even more important for patients with metabolic syndrome.

If you are unable to achieve your goals with lifestyle changes, your doctor may also prescribe drugs to lower blood pressure, control cholesterol or help you lose weight. Aspirin therapy may help reduce your risk of heart attack.

READERS: About one-third of Americans over age 60 and as much as 50 percent of adults 75 and older have hearing loss.

An audiologist can assess your hearing loss and measure the severity through various tests. Factors that contribute to hearing loss include aging, loud noises, heredity, certain medications and some illnesses. Often, hearing loss identified early can be helped.