ReviewThe metabolic syndrome: Validity and utility of clinical definitions for cardiovascular disease and diabetes risk prediction
Introduction
The term “metabolic syndrome” has developed to describe those individuals at increased risk of type 2 diabetes and cardiovascular diseases (CVD) due to the metabolic dysfunction commonly seen in individuals with insulin resistance. Clinical definitions of the metabolic syndrome have been developed in the last two decades, with a primary purpose being to assist in the identification of those at increased diabetes and CVD risk in order to put in place preventive measures that can reduce this risk [1], [2], [3], [4], [5]. As clinical constructs, these do not need to include all of the abnormalities associated with the metabolic dysfunction characteristic of the syndrome, and even include central obesity which is more often thought to be a cause rather than a consequence of metabolic dysfunction. Despite evidence supporting their ability to independently predict both type 2 diabetes and CVD, the various clinical definitions of the metabolic syndrome have been the subject of considerable controversy [6], [7], [8], [9], [10], [11], [12], [13]. Commentators have questioned their validity and utility for use in clinical practice and as a public health tool because of the existence of multiple competing definitions and because other tools appear to be more useful for the prediction of CVD and type 2 diabetes. With the recent publication of a consensus definition of the metabolic syndrome [5], it is timely to review the evidence for its use in the prediction of CVD and diabetes risk.
Section snippets
Issues relating to clinical definitions for the metabolic syndrome
The recent publication of a consensus statement on the definition of the metabolic syndrome, representing the views of six major organisations and societies, will hopefully prove to be a pivotal point in the development of the metabolic syndrome as a tool for clinical and public health use [5]. A major criticism levelled at the metabolic syndrome has been that multiple competing definitions are at best confusing, and at worst represent a syndrome which nobody knows how to define. The consensus
The role of obesity in clinical definitions of the metabolic syndrome
Obesity is frequently cited as being a leading cause of the metabolic syndrome. In a review of the metabolic syndrome after menopause, Lobo commented that the increased prevalence of the metabolic syndrome among women post-menopause is a result chiefly of weight gain and obesity in this group [18]. The major difference between the IDF and AHA/NHLBI metabolic syndrome definitions is the priority given to obesity. In the IDF definition, one cannot be diagnosed without being obese. Critics of this
The metabolic syndrome as a tool for prediction of incident type 2 diabetes and CVD
Numerous studies have quantified the risk for type 2 diabetes and CVD associated with clinical definitions of the metabolic syndrome. A recent meta-analysis of the studies examining risk for incident diabetes showed that for those definitions published prior to the recent consensus statement, the metabolic syndrome conferred a relative risk of between 3.1 and 5.1 [28]. A similar meta-analysis focused on CVD showed that the metabolic syndrome is a comparatively poor predictor of CVD (estimated
Conclusions
The increase in the prevalence of obesity and the metabolic syndrome since the middle of the twentieth century is threatening to prevent achievement of the millennium development goals, with the increasing global burden of non-communicable diseases being described as the new agenda for global public health [37]. Clinical definitions of the metabolic syndrome, while therefore obviously important, have frequently been criticized for being sub-optimal in their ability to predict the development of
Conflict of interest
None declared.
Provenance
Commissioned and externally peer reviewed.
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