Metabolic Syndrome and Type 2 Diabetes/CVD Risk
The recognition of the metabolic syndrome as a risk factor for type 2 diabetes and cardiovascular disease (CVD) in the NCEP-ATP III and IDF guidelines has had important clinical/public health ramifications. Gaining ground is the notion that the most prevalent form of the metabolic syndrome is associated with abdominal obesity, especially when accompanied by excess intra-abdominal (visceral) fat. This form of adiposity has been strongly linked to a cluster of diabetogenic and atherogenic metabolic abnormalities known as the metabolic syndrome, which substantially increases CVD risk, even in the absence of traditional risk factors. Because abdominal adiposity can be assessed through simple anthropometric measurements such as waist circumference, this approach is often used to identify abdominally obese patients with the most prevalent form of the metabolic syndrome. The current debate about the relevance of considering the metabolic syndrome in clinical practice highlights the fact that pathophysiology and clinical screening tools have often been confused. Much additional research will be needed to determine which key features of the metabolic syndrome further contribute to global CVD risk (as assessed by classical risk factors). Moreover, simple and effective tools must be developed for health professionals as there is an urgent need to identify these high-risk abdominally obese patients. So far, several organizations and groups have proposed clinical tools to identify patients likely to have features of the metabolic syndrome (hypertriglyceridemic waist, NCEP-ATP III, IDF, WHO, EGIR, AACE). Regardless of whether one recognizes that this syndrome really exists, there is compelling evidence that the abdominal obesity and type 2 diabetes epidemics represent a major threat to the cardiovascular health of most populations worldwide.