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| Home > Evidence of the Month > Archive | |
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| December 2005 Evidence of the Month |
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United States Associations Review Definition of Metabolic Syndrome
Dr Tony O’Sullivan
Irishtown Health Centre
Dublin, Ireland
Comment on:
International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome.
Background
The metabolic syndrome, a cluster of conditions including obesity, dyslipidaemia, hypertension, and impaired glucose tolerance, is highly prevalent throughout the world, yet specific definitions and diagnostic criteria vary among countries and regions.
Methods
The statement by Grundy et al is a review of the existing United States National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for the diagnosis of the metabolic syndrome in the context of developing knowledge and changing diagnostic criteria.
Key Results
The American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) recommend continued use of ATP III diagnostic criteria with the adjustment that treated hypertension counts towards diagnosis and that the new, lower American Diabetes Association (ADA) diagnostic criterion for impaired fasting glucose (>100 mg/dl [5.6 mmol/l]) be adopted. This statement notes that the new IDF statement on metabolic syndrome insists on raised waist circumference (WC) as a fundamental criterion and proposes different cut-points for WC in different populations. However, for the AHA/NHBLI statement, the existing ATP III WC criteria for Americans continue, and WC is not an essential component.
The main aim of management is reduction of cardiovascular disease (CVD) risk. Those with established diabetes or CVD require aggressive reduction of all risk factors, while for others the 10-year risk depends on Framingham scoring. For people with metabolic syndrome, longer-term risk is elevated regardless, and hence lifestyle modification should be first-line treatment for all. Other risk-factor interventions including drugs are appropriate for those with higher 10-year Framingham risk scores. No drugs are recommended specifically for the metabolic syndrome. Treatment targets for lipids, blood pressure, and A1C in very high risk patients are
- LDL cholesterol: <70 mg/dl (1.81 mmol/l)
- Non–HDL cholesterol (if TG >200 mg/dl [5.18 mmol/l]): <100 mg/dl (2.6 mmol/l)
- HDL cholesterol: men, >40 mg/dl (1.04 mmol/l); women, >50 mg/dl (1.23 mmol/l)
- BP: without diabetes, <140/90 mm Hg; with diabetes, BP <130/80 mm Hg
- A1C: <7.0%
Aspirin and/or clopidigrel are recommended for patients at medium and high risk for CVD.
Clinical Relevance
This article represents a further contribution to the renewed debate about the relevance of the metabolic syndrome, recently opened by Kahn and Ferrannini in a joint ADA/EASD statement, and defended by Alberti and Zimmet on behalf of the IDF. Even though this debate is not divided across the Atlantic, I sense a collegial support among American associations with this statement. At least it is an attempt to offer practical updated guidance, and it gives some direction to a front-line clinician like me. Most encouraging is the statement that “in the long run the greatest benefit for those with metabolic syndrome will be derived from lifestyle intervention.”
This Website Feature is funded by an unrestricted educational grant from sanofi-aventis and Pfizer Inc.
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