Metabolic Syndrome Worksheet

To help manage your condition, fill in the dates and your results from these tests or checkups. Then list your goals for your next visit with your healthcare provider.

Lipid profile

I had a lipid profile on ____________________. My results were ________________________________________.

A lipid profile is a lab test that measures the amount of certain fats and cholesterol in your blood. High lipid levels can lead to a heart attack or worsen heart disease. You should have a lipid profile at least once a year.

Maintain healthy levels of LDL ("bad") cholesterol and HDL ("good") cholesterol. Healthy levels of LDL and HDL may vary depending on your health conditions or risk factors. Your triglycerides (also "bad") should be less than 150 mg/dL. Talk with your healthcare provider about helping you set and meet your goals.

Blood pressure

My blood pressure was taken on ______________________. My blood pressure is _______________________.

High blood pressure (hypertension) can lead to serious health problems. Blood pressure-lowering medicines along with lifestyle changes can achieve the best results. High blood pressure is defined as 130/80 mmHg or higher. Make sure that your blood pressure is checked every time you visit your healthcare provider. If you have high blood pressure, ask your provider if you should also be checking your blood pressure at home.


I talked with my provider about quitting smoking on _______________.

If you smoke, get help to quit. Cigarette smoking is a strong risk factor for heart disease and many other health problems. As soon as you quit, your blood vessels start to return to normal. Talk with your healthcare provider about programs or medicines that can help you quit.

Blood sugar

I had my blood sugar checked on ______________________. My results were ______________________.

Have your blood sugar checked at regular intervals as advised by your healthcare provider. Early detection and treatment of high blood sugar will help prevent diabetes or delay the progression of serious complications in adults with diabetes.

Weight management

I weigh __________ pounds. I talked with my provider about how to manage my weight on ______________. My waist measurement (measured just above my hips, as I breathed out) was _______________ on __________.

Losing just 5% to 10% of your weight or 2 inches from your waist can make you healthier. It's better to lose a small amount of weight and keep it off than to lose a lot of weight fast and gain it back. Take the time to read food labels to avoid calories from added sugar. Lowering these risks of metabolic syndrome also reduce your risk of developing several other serious conditions. These include fatty liver disease, polycystic ovarian disease (PCOS), sleep apnea, gout, and chronic kidney disease.


I talked with my provider about medicines to help lower my risk for heart disease on __________. Several medicines can help treat or prevent heart disease in many people.


My goals for my next visit with my healthcare provider are: _________________________________





Online Medical Reviewer: Dan Brennan MD
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Online Medical Reviewer: Ricardo Rafael Correa Marquez MD
Date Last Reviewed: 5/1/2023
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