| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
PERSPECTIVE |
1 From the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
ABSTRACT
Values of insulin-mediated glucose disposal vary continuously throughout a population of apparently healthy persons, and a difference of 
600% exists between the most insulin-sensitive and the most insulin-resistant persons. Approximately 50% of this variability can be attributed to differences in adiposity (25%) and fitness (25%), with the remaining 50% likely of genetic origin. The more insulin-resistant a person, the more likely that he or she will develop some degree of glucose intolerance, high triacylglycerol and low HDL concentrations, essential hypertension, and procoagulant and proinflammatory states, all of which increase the risk of cardiovascular disease (CVD). To identify persons at greater CVD risk because of these abnormalities, the World Health Organization, the Adult Treatment Panel III, and the International Diabetes Federation created a new diagnostic category, the metabolic syndrome. Although the components of the 3 versions of the metabolic syndrome are similar, the specific values for those components that define an abnormality are somewhat different, and the manner in which the abnormalities are used to make a positive diagnosis varies dramatically from version to version. This review will summarize the similarities in and differences between the 3 versions of the metabolic syndrome, point out that the clustering of components that make up all 3 definitions of the metabolic syndrome is not accidental and occurs only in insulin-resistant persons, develop the argument that diagnosing the metabolic syndrome in a person has neither pedagogical nor clinical utility, and suggest that the clinical emphasis should be on treating effectively any CVD risk factor that is present.
Key Words: Metabolic syndrome • insulin resistance • cardiovascular disease
This article has been cited by other articles:
|
|
 |
|
  K D Bruce and C D Byrne The metabolic syndrome: common origins of a multifactorial disorder Postgrad. Med. J., November 1, 2009; 85(1009): 614 - 621. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Bullon, J.M. Morillo, M.C. Ramirez-Tortosa, J.L. Quiles, H.N. Newman, and M. Battino Metabolic Syndrome and Periodontitis: Is Oxidative Stress a Common Link? Journal of Dental Research, June 1, 2009; 88(6): 503 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. L. Huang A comprehensive definition for metabolic syndrome Dis. Model. Mech., May 1, 2009; 2(5-6): 231 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Shimada, T. Akase, M. Kosugi, and M. Aburada Preventive Effect of Boiogito on Metabolic Disorders in the TSOD Mouse, a Model of Spontaneous Obese Type II Diabetes Mellitus Evid. Based Complement. Altern. Med., February 10, 2009; (2009) nep012v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Sheikh Metabolic Syndrome and Stroke Stroke, November 1, 2008; 39(11): e163 - e163. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Buchner, L. C. Burrage, A. E. Hill, S. N. Yazbek, W. E. O'Brien, C. M. Croniger, and J. H. Nadeau Resistance to diet-induced obesity in mice with a single substituted chromosome Physiol Genomics, September 17, 2008; 35(1): 116 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Stienstra, C. Duval, S. Keshtkar, J. van der Laak, S. Kersten, and M. Muller Peroxisome Proliferator-activated Receptor {gamma} Activation Promotes Infiltration of Alternatively Activated Macrophages into Adipose Tissue J. Biol. Chem., August 15, 2008; 283(33): 22620 - 22627. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-P. Despres, I. Lemieux, J. Bergeron, P. Pibarot, P. Mathieu, E. Larose, J. Rodes-Cabau, O. F. Bertrand, and P. Poirier Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk Arterioscler Thromb Vasc Biol, June 1, 2008; 28(6): 1039 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. K Layman, P. Clifton, M. C Gannon, R. M Krauss, and F. Q Nuttall Protein in optimal health: heart disease and type 2 diabetes Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1571S - 1575S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Berglund, M. Lefevre, H. N Ginsberg, P. M Kris-Etherton, P. J Elmer, P. W Stewart, A. Ershow, T. A Pearson, B. H Dennis, P. S Roheim, et al. Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states Am. J. Clinical Nutrition, December 1, 2007; 86(6): 1611 - 1620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Pellitero, J. L. Reverter, E. Pizarro, M. C. Pastor, M. L. Granada, D. Tassies, J.-C. Reverter, I. Salinas, and A. Sanmarti Pregnancy-Associated Plasma Protein-A Levels Are Related to Glycemic Control but Not to Lipid Profile or Hemostatic Parameters in Type 2 Diabetes Diabetes Care, December 1, 2007; 30(12): 3083 - 3085. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Schindler Review: The metabolic syndrome as an endocrine disease: is there an effective pharmacotherapeutic strategy optimally targeting the pathogenesis? Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 7 - 26. [Abstract] [PDF]
|
|
|
|
|
|
P. Margozzini, A. Rigotti, C. Ferreccio, N. Quezada, M. Garrido, and G. Valdes Review: Hypertension and the cardiometabolic syndrome in Chile: a review of concepts and consequences for the developing world Therapeutic Advances in Cardiovascular Disease, October 1, 2007; 1(1): 83 - 90. [Abstract] [PDF]
|
|
|
|
|
|
I. Levinger, C. Goodman, D. L. Hare, G. Jerums, and S. Selig The Effect of Resistance Training on Functional Capacity and Quality of Life in Individuals with High and Low Numbers of Metabolic Risk Factors Diabetes Care, September 1, 2007; 30(9): 2205 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ingelsson, M. J. Pencina, G. H. Tofler, E. J. Benjamin, K. J. Lanier, P. F. Jacques, C. S. Fox, J. B. Meigs, D. Levy, M. G. Larson, et al. Multimarker Approach to Evaluate the Incidence of the Metabolic Syndrome and Longitudinal Changes in Metabolic Risk Factors: The Framingham Offspring Study Circulation, August 28, 2007; 116(9): 984 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Morrison, L. A. Friedman, and C. Gray-McGuire Metabolic Syndrome in Childhood Predicts Adult Cardiovascular Disease 25 Years Later: The Princeton Lipid Research Clinics Follow-up Study Pediatrics, August 1, 2007; 120(2): 340 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. S. Blaum, N. A. West, and M. N. Haan Is the Metabolic Syndrome, With or Without Diabetes, Associated With Progressive Disability in Older Mexican Americans? J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2007; 62(7): 766 - 773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, M. A. Moro, and A. Davalos The Metabolic Syndrome and Stroke: Potential Treatment Approaches Stroke, July 1, 2007; 38(7): 2196 - 2203. [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Reaven The Individual Components of the Metabolic Syndrome: Is There a Raison d'Etre? J. Am. Coll. Nutr., June 1, 2007; 26(3): 191 - 195. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Barter, Y. R. McPherson, K. Song, Y. A. Kesaniemi, R. Mahley, G. Waeber, T. Bersot, V. Mooser, D. Waterworth, and S. M. Grundy Serum Insulin and Inflammatory Markers in Overweight Individuals with and without Dyslipidemia J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 2041 - 2045. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ingelsson, L. M. Sullivan, J. M. Murabito, C. S. Fox, E. J. Benjamin, J. F. Polak, J. B. Meigs, M. J. Keyes, C. J. O'Donnell, T. J. Wang, et al. Prevalence and Prognostic Impact of Subclinical Cardiovascular Disease in Individuals With the Metabolic Syndrome and Diabetes Diabetes, June 1, 2007; 56(6): 1718 - 1726. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Q. Shaibi, M. L. Cruz, M. J. Weigensberg, C. M. Toledo-Corral, C. J. Lane, L. A. Kelly, J. N. Davis, C. Koebnick, E. E. Ventura, C. K. Roberts, et al. Adiponectin Independently Predicts Metabolic Syndrome in Overweight Latino Youth J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1809 - 1813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Razak, S. S. Anand, H. Shannon, V. Vuksan, B. Davis, R. Jacobs, K. K. Teo, M. McQueen, S. Yusuf, and for the SHARE Investigators Defining Obesity Cut Points in a Multiethnic Population Circulation, April 24, 2007; 115(16): 2111 - 2118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Beaser and P. Levy A Work in Progress, but a Useful Construct Circulation, April 3, 2007; 115(13): 1812 - 1818. [Full Text] [PDF]
|
|
|
|
 |
|
 T. B. Repas Challenges and Strategies in Managing Cardiometabolic Risk J Am Osteopath Assoc, April 1, 2007; 107(4_suppl_2): S4 - S11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Grundy Metabolic Syndrome: A Multiplex Cardiovascular Risk Factor J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 399 - 404. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M Zivkovic and J B. German Individual variation in the metabolic syndrome: a new perspective on the debate Am. J. Clinical Nutrition, January 1, 2007; 85(1): 240 - 241. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Wolk and V. K. Somers Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Sleep and the metabolic syndrome Exp Physiol, January 1, 2007; 92(1): 67 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Sturmer, J. E. Buring, I-M. Lee, J. M. Gaziano, and R. J. Glynn Metabolic Abnormalities and Risk for Colorectal Cancer in the Physicians' Health Study Cancer Epidemiol. Biomarkers Prev., December 1, 2006; 15(12): 2391 - 2397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Oda Criteria for diagnosing the metabolic syndrome. Am. J. Clinical Nutrition, November 1, 2006; 84(5): 1251 - 1252. [Full Text] [PDF]
|
|
|
|
|
|
G. Reaven Reply to E Oda Am. J. Clinical Nutrition, November 1, 2006; 84(5): 1252 - 1252. [Full Text] [PDF]
|
|
|
|
|
|
E. Oda The metabolic syndrome (emperor) wears no clothes: response to kahn. Diabetes Care, November 1, 2006; 29(11): 2566 - 2566. [Full Text] [PDF]
|
|
|
|
|
|
S. M Grundy Does a diagnosis of metabolic syndrome have value in clinical practice? Am. J. Clinical Nutrition, June 1, 2006; 83(6): 1248 - 1251. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
