In search of a clinical role
- James B. Meigs, MD, MPH
- From the General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
- Address correspondence to James B. Meigs, General Medicine Division, Massachusetts General Hospital, 50 Staniford St., 9th floor, Boston, MA 02114. E-mail:
The concept of a “metabolic syndrome ” conferring increased risk of incident type 2 diabetes and cardiovascular disease (CVD) has been around for more than a couple of decades. Recent publication of clinical definitions has transformed the metabolic syndrome from a physiological curiosity to a major focus of research and of clinical and public health interest (1,2). The metabolic syndrome is generally considered to be the co-occurrence of obesity (particularly central obesity); elevated glucose, triglyceride, and blood pressure levels; and/or low HDL cholesterol levels, and in many cases their co-occurrence signifies underlying insulin resistance (3). The metabolic syndrome has been most widely promoted as a means to identify patients for lifestyle interventions to reduce risk factor levels and, theoretically, incident disease, particularly CVD. However, various tools already exist for the identification of apparently healthy people at elevated risk of diabetes (4–6) or CVD (7). The degree to which a clinical diagnosis of the metabolic syndrome complements or improves upon risk prediction using existing methods has not been defined.
In this issue of Diabetes Care, Stern et al. (8) address this question using the experience of Mexican American and non-Hispanic white participants in the San Antonio Heart Study (SAHS). After a baseline examination and 7 years of follow-up, 195 subjects subsequently developed type 2 diabetes out of 1,709 subjects without baseline diabetes (defined by diabetic hyperglycemia or self-reported use of diabetes medications) and 156 experienced a CVD event out of 2,570 subjects without baseline CVD (defined as self-reported physician diagnosis of heart attack, revascularization procedure, stroke, or CVD death by death certificate). Clinical history and metabolic risk factors measured at baseline were used to categorize subjects with the metabolic syndrome by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria (or World Health Organization …