Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 29:177-178, 2006
DOI: 10.2337/diacare.29.01.06.dc05-2007
© 2006 by the American Diabetes Association
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kahn, R.
Right arrow Articles by Stern, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Kahn, R.
Right arrow Articles by Stern, M.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Letters: Comments and Responses

The Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes

Response to Citrome et al., Giugliano and Esposito, Cheta, and Psaty et al.

Richard Kahn, PHD1, John Buse, MD, PHD2, Ele Ferrannini, MD3 and Michael Stern, MD4

1 American Diabetes Association, Alexandria, Virginia
2 Departments of Endocrinology and Medicine, University of North Carolina, Chapel Hill, North Carolina
3 Department of Medicine, Clinical Physiology, CNR Institute, Pisa, Italy
4 Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Address correspondence to Richard Kahn, PhD, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: rkahn{at}diabetes.org

Citrome et al. (1) seem to agree with our review (2) of all the shortcomings associated with the metabolic syndrome, yet they claim it is somehow still an aid in identifying risk factors and in the "ongoing education of practitioners," both of which may improve health care. This seems perplexing because what must occur prior to making the "diagnosis" is knowledge of the components, and thus, a priori, the provider must be familiar with the cardiovascular disease (CVD) risk factors that comprise the concept and that the factors must be monitored. Moreover, many other CVD risk factors (e.g., LDL cholesterol, smoking, age, family history) do not require a phrase to prompt doctors to test, yet medical history taking and cholesterol testing do not seem to have suffered because of the absence of an associated syndrome.

Giugliano and Esposito (3) highlight a very important concept. That is, current definitions of the syndrome are "polluted by inclusion of patients with frank diseases." We couldn’t agree more, and that error compounds the inability of the definition to serve a useful purpose. Unfortunately, although there are an innumerable number of articles describing CVD risk in metabolic syndrome patients who were not distinguished by the values of the risk factors present, we have no similar information on risk in so-called borderline patients using current syndrome definitions. Even so, the report by Vasan et al. (4) suggests that borderline risk factors generally convey very little CVD risk. Moreover, if we had this information, we might find that most of the risk was confined to one or two factors and that here too, we don’t need a "syndrome" to tell us what to do.

Cheta (5) emphasizes the importance of obesity as a major (key) CVD risk factor. We agree but would not go so far as to create a new syndrome. The underlying pathophysiology of obesity that results in other disorders is complex and likely multifactorial. But here too, we don’t need the syndrome label to tell people that being overweight is hazardous to their health. Whether patients respond better when labeled with a "syndrome" or told they have a CVD risk factor(s) is unknown, but we prefer the "truth in labeling" option.

All of these authors (1, 3, 5) suggest that using the ominous "you’ve got the metabolic syndrome" label results in better adherence to recommendations. We would very much like to see the evidence that such labeling leads to improved compliance with recommended changes in lifestyle. It may in fact lead to the reverse (i.e. to denial) or, perhaps worse, may deflect attention from other more important CVD risk factors (e.g., LDL or smoking).

Psaty et al. (6) accurately paraphrased a key message we tried to convey. That is, regardless of what one thinks of the etiology, definition, or purpose of the metabolic syndrome, it remains crucial to appropriately address all cardiovascular risk factors. Borderline values call for lifestyle modification, and overt disease often requires pharmacologic therapy.

References

  1. Citrome L, Holt RIG, Dinan TG: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (Letter). Diabetes Care 29:176, 2006[Free Full Text]
  2. Kahn R, Buse J, Ferrannini E, Stern M: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28:2289–2304, 2005.[Abstract/Free Full Text]
  3. Guigliano D, Esposito K: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (Letter). Diabetes Care 29:175, 2006[Free Full Text]
  4. Vasan RS, Sullivan LM, Wilson PW, Sempos CT, Sundstrom J, Kannel WB, Levy D, D’Agostino RB: Relative importance of borderline and elevated levels of coronary heart disease risk factors. Ann Intern Med 142:393–402, 2005[Abstract/Free Full Text]
  5. Cheta DM: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (Letter). Diabetes Care 29:176–177, 2006[Free Full Text]
  6. Psaty BM, Lumley T, Furberg CD: The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (Letter). Diabetes Care 29:177, 2006[Free Full Text]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kahn, R.
Right arrow Articles by Stern, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Kahn, R.
Right arrow Articles by Stern, M.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum