Metabolic Syndrome and Diabetic Risk

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The metabolic syndrome has been sometimes been linked to the development of diabetes mellitus 2 and cardiovascular disease, suggesting the syndrome represents a risk “greater than the sum of its parts.”

The syndrome has various definitions, but many have accepted the International Diabetes Foundation’s (IDF) definition; abdominal obesity plus two of the following: triglycerides > 150 mg/dL, HDL < 40, hypertension, and impaired fasting glucose. However there has been considerable debate whether metabolic syndrome truly is a distinct syndrome or just a group of conditions that happen to co-exist. Two prospective studies reported in the Lancet, the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) and the British Regional Heart Study, examined the supposed association of metabolic syndrome with the development of DM2 or CVD. In PROSPER, the metabolic syndrome was not associated with increased risk of cardiovascular disease (HR 1.07, 95% CI 0.86 to 1.32) but was highly associated with a greater risk of diabetes (HR 4.41, 95% CI 3.33 to 5.84). Curiously, neither the metabolic syndrome nor any of its components were significantly associated with the development of CVD in the PROSPER trial. The British Regional Heart Study (n= 2,737 males) did find a small association between metabolic syndrome and CVD (HR 1.27, 95% CI 1.04 to 1.56), but having the syndrome wasmore strongly predictive of the development of DM2 (HR 7.47, 95% CI 4.90 to 11.46). The new findings thereforeshow that the metabolic syndrome does not usefully predict a simultaneous risk of DM and CVD. The authors recommend that clinicians should focus on a global assessment of CVD risk based on previously validated criteria (for instance Framingham) rather than chasing down the rather cumbersome diagnosis of metabolic syndrome.