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The Coming of Age of the Metabolic Syndrome

Outcomes Resolution and Management, Merck & Co., West Point, Pennsylvania

Address correspondence and reprint requests to Dr. Charles M. Alexander, Broad St. and Sumneytown Pike, WP39-170 West Point, PA 19486-0004. E-mail: charles_alexander@merck.com

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The metabolic syndrome, or insulin resistance syndrome, is present in almost one-half of older individuals and is associated with dyslipidemia (especially low HDL cholesterol, increased triglycerides, and apolipoprotein B levels), hypertension, insulin resistance/glucose intolerance/hyperglycemia, and visceral adiposity (as well as lipid deposition in other nonadipose sites) (1). Although the term "insulin resistance syndrome" has many supporters among the diabetes community, many others (especially cardiologists) favor the term "the metabolic syndrome," which will be used here.

In many countries, the prevalence of the metabolic syndrome appears to be increasing along with BMI, especially in younger individuals. Onset varies from adolescence in the most severe cases to the very elderly. Prevalence varies markedly by race/ethnicity and the environment. Those ethnic/racial groups in the U.S. living in environments with high-sugar, high-fat food and little physical activity have an extremely high prevalence of the metabolic syndrome (e.g., Pima Indians in Arizona compared with Mexico). Most individuals with type 2 diabetes have the metabolic syndrome. Although it is suspected to predate the onset of diabetes, longitudinal studies of individuals with the metabolic syndrome are needed to confirm this. It is clear that there is a step-wise increase in prevalence of the metabolic syndrome with increasing glucose intolerance/hyperglycemia. The major consequences of the metabolic syndrome are . . . [Full Text of this Article]

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