Evaluating CMR

Metabolic Syndrome and Type 2 Diabetes/CVD Risk

Usefulness of Hypertriglyceridemic Waist

Hypertriglyceridemic Waist and Global CHD Risk

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Although hypertriglyceridemic waist is very helpful in clinical practice as a screening tool for identifying patients with the metabolic syndrome, the presence of hypertriglyceridemic waist does not necessarily mean that the patient is at high absolute risk of CHD. The diagnosis of hypertriglyceridemic waist should therefore not be considered in isolation to quantify global CHD risk. Rather, improved global risk assessment algorithms are needed to quantify diabetes and CVD risk resulting from the presence of classical risk factors as well as capture the additional risk caused by abdominal obesity/insulin resistance-related metabolic markers (metabolic syndrome). This overall risk is referred to as global ‘cardiometabolic risk’ (4). Cardiometabolic risk encompasses the global risk of CVD and type 2 diabetes associated with classical risk factors, while also taking into account the additional contribution of abdominal obesity/insulin resistance and related metabolic markers (to be identified) to global CVD risk. Whether the clinical criteria of the metabolic syndrome add to global CVD risk remains uncertain and is a matter of debate. Only additional prospective studies to directly measure sophisticated metabolic markers and intra-abdominal and subcutaneous adiposity can answer this important question. Once these findings are released, we should be better able to define what constitutes a high-risk abdominal obesity phenotype in various regions of the world and elucidate key determinants of risk in different populations.

In summary, because the metabolic syndrome increases the risk of type 2 diabetes and CVD, a number of organizations have proposed screening approaches to identify patients with features of the metabolic syndrome. However, the range of variables and cutoffs proposed has sometimes left clinicians feeling confused and perplexed. Based on evidence that waist circumference and triglycerides may be as good as other, more demanding approaches such as the NCEP-ATP III criteria, hypertriglyceridemic waist may be the simplest tool available for quick initial screening of the metabolic syndrome in clinical practice. However, additional prospective studies are necessary to validate fasting triglyceride concentrations and waist circumference cutoff values in various ethnic populations, in both genders, and across different age groups.

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4. Després JP and Lemieux I. Abdominal obesity and metabolic syndrome. Nature 2006; 444: 881-7.