The Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement From the American Diabetes Association and the European Association for the Study of Diabetes : Response to Kahn et al.

We have known for years that major cardiovascular risk factors such as obesity, high blood pressure, diabetes, and dyslipidemia tend to cluster. One of the names associated with that clustering—the metabolic syndrome—has recently become popular. The fine epidemiologic review by Kahn et al. (1) may enable us to gain new insight into its etiology, prognosis, and treatment. Like Gale (2), they challenge scientists studying the metabolic syndrome to consider the definition of its elements and what additional information these elements, in combination, may contribute to the risk of cardiovascular disease. Hypertension and dyslipidemia as risk factors can perhaps serve as a model. Their independent contribution to the risk of cardiovascular events was first identified. Later, effective treatments were evaluated in large long-term clinical trials that defined the standards of care for high levels of blood pressure and cholesterol (3, 4). The critical appraisal of Kahn et al. may be a turning point for the metabolic syndrome. Until this sort of high-quality effort is devoted to the metabolic syndrome, it is premature to introduce the current definitions of the metabolic syndrome into clinical medicine or public health practice. In the meantime, clinicians are well advised to appropriately treat the individual risk factors, many of which are improved by the nonpharmacologic approaches of diet, weight loss, and exercise.