The metabolic syndrome: Is it still alive?

The metabolic syndrome is very common in the general population and is defined by the clustering of several cardiovascular risk factors, such as type 2 diabetes, hypertension, high triglyceride and low high density lipoprotein cholesterol. Central obesity and insulin resistance are underlying disorders of the syndrome as well as further risk factors for cardiovascular disease. Moreover, a panel of novel, non-traditional risk factors are ancillary features of the metabolic syndrome. They include biomarkers of chronic mild inflammation (e.g., C-reactive protein), oxidant stress (e.g., oxidized low density lipoprotein), thrombophilia (e.g., Plasminogen Activator Inhibitor-1), abnormal adipocyte activity (e.g., adiponectin), and endothelial dysfunction (e.g., E-selectin). Therefore, subjects with the metabolic syndrome are potentially at high risk of developing atherosclerosis and clinical cardiovascular events. In recent years several longitudinal studies have confirmed that subjects with the metabolic syndrome present with atherosclerosis and suffer from myocardial infarction and stroke at rates higher than subjects without the syndrome. The risk of cardiovascular disease is particularly high in women with the syndrome and in subjects with pre-existing diabetes and cardiovascular disease. However, an increased risk is already present in subjects with a cluster of multiple mild abnormalities. The risk related to the metabolic syndrome is definitely higher when subjects affected are compared to subjects free of any metabolic abnormality. Although many aspects related to the metabolic syndrome need to be better elucidated, and several concerns recently raised about the syndrome need to be adequately addressed by further investigations, the clinical value of identifying subjects with this common metabolic condition seems fully valid.