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(Hypertension. 2007;50:e5.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Metabolic Syndrome and Early Death

Stephen Colagiuri

Faculty of Medicine, University of Sydney, Sydney, Australia

Crystal M.Y. Lee; Rachel Huxley

The George Institute for International Health, University of Sydney, Sydney, Australia

Mark Woodward

Department of Medicine, Mount Sinai Medical Center, New York, NY

To the Editor:

The editorial by Franks and Olsson¹ highlights the heterogeneous nature of definitions of the metabolic syndrome, which results from the number of different combinations of risk factors that equate with a diagnosis of the syndrome.

However, the situation is even more complex than indicated in Figure 2 of their editorial. There are, in fact, 16 permutations of components of the metabolic syndrome as defined by the Adult Treatment Panel III definition²: 10 for combinations of 3 metabolic syndrome components, 5 for combinations of 4 metabolic syndrome components, and 1 for the combination of all 5 metabolic syndrome components (Table). The situation is similar for the International Diabetes Federation definition of the metabolic syndrome in which there are 11 possible combinations in people who meet the abdominal obesity criteria.³

View this table: [in this window] [in a new window]   Combinations of Metabolic Components That Define Metabolic Syndrome Using the National Cholesterol Education Program Adult Treatment Panel III Definition

Studies that we are currently undertaking show that the prevalence of each of these individual combinations varies considerably within and between populations. In addition, as shown in the Pressioni Arteriose Monitorate e Loro Associazioni Study, outcomes may also differ according to particular combinations of risk factors used to diagnose the metabolic syndrome.⁴

The limitations of approaches that count metabolic risk factors using artificial thresholds were highlighted recently by our group in an analysis of >300 000 subjects.⁵ Statistical models using the "3 or more positive" rule performed much poorer than models that scored the number (of 5) risk factors positive (on a 0 to 5 scale), whereas each was dominated significantly by a model that took all 5 of the metabolic risk factors as continuous variables.

Although the metabolic syndrome may be useful for epidemiological studies and as a public health message, the above observations highlight the limitations of the clinical implications of a diagnosis of the metabolic syndrome in individual patient care.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 

1. Franks PW, Olsson T. Metabolic syndrome and early death. getting to the heart of the problem. Hypertension. 2007; 49: 10–12.[Free Full Text]
2. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285: 2486–2497.[Free Full Text]
3. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome; 2005. Available at: http://www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf. Accessed March 2, 2007.
4. Mancia G, Bombelli M, Corrao G, Facchetti R, Madotto F, Giannattasio C, Trevano FQ, Grassi G, Zanchetti A, Sega R. Metabolic syndrome in the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study. Daily life blood pressure, cardiac damage, and prognosis. Hypertension. 2007; 49: 40–47.[Abstract/Free Full Text]
5. Asia Pacific Cohort Studies Collaboration. An evaluation of metabolic risks for coronary death in the Asia Pacific region. Diab Res Clin Pract. 2006; 74: 274–281.[CrossRef][Medline] [Order article via Infotrieve]

This article has been cited by other articles:

				P. W. Franks and T. Olsson Response to Metabolic Syndrome and Early Death: Extending the Discussion on Heterogeneity Hypertension, July 1, 2007; 50(1): e6 - e6. [Full Text] [PDF]

This Article Extract Full Text (PDF) All Versions of this Article: 50/1/e5    most recent HYPERTENSIONAHA.107.091439v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colagiuri, S. Articles by Woodward, M. Search for Related Content PubMed PubMed Citation Articles by Colagiuri, S. Articles by Woodward, M. Related Collections Epidemiology