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More on the metabolic syndrome

New Definition of Metabolic Syndrome Improves CHD and Diabetes Risk Prediction

Under the NCEP definition, metabolic syndrome is diagnosed if at least three of five criteria are present: increase waist circumference, elevated triglyceride levels, low HDL cholesterol levels, increased blood glucose levels, and hypertension. In the new study, Dr. Sattar’s team used BMI instead of waist circumference.

The previous definition, which was created by the World Health Organization, was more complex and relied heavily on evidence of glucose dysregulation. The problem was that by the time such dysregulation was present, the opportunity for preventing diabetes was limited, the researchers note.

Dr. Sattar’s group followed more than 5000 men for nearly 5 years to assess the incidence of CHD and diabetes. At baseline, all of the subjects were evaluated for metabolic syndrome based on the modified definition.

Twenty-six percent of the men met criteria for metabolic syndrome, the authors note. Overall, such men were 76% more likely to develop CHD and 3.5-times more likely to develop diabetes than were men without the disorder. When the analysis was limited to men with four or five criteria, the increased risks were even more dramatic–a 3.7-fold increase for CHD and a 24.4-fold increase for diabetes (p < 0.0001 for both).

 

While we do not yet understand completely the physiology of this syndrome (one could call this problem the genotype), we certainly recognize the phenotype. Physicians implicitly recognize these patients. They populate our offices and our wards. I believe that patients can often prevent this syndrome.

These findings strengthen the call for exercise and prudent diet. Now we need to develop methods for inducing ourselves and our patients to exercise and eat more healthy. As Hamlet says in his famous speech: Aye, there’s the rub!

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