Editors' ChoiceMetabolic Syndrome

Harbingers of Metabolic Havoc

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Science Translational Medicine  02 Dec 2009:
Vol. 1, Issue 9, pp. 9ec32
DOI: 10.1126/scitranslmed.3000669

Physicians typically make a diagnosis of metabolic syndrome when three out of a collection of five symptoms—high blood pressure, central adiposity, hyperglycemia, higher-than-normal concentrations of blood triglycerides, and lower-than-normal high density lipoprotein (HDL) cholesterol—occur together in a patient. Metabolic syndrome is associated with an increased risk of developing type 2 diabetes, cardiovascular disease, and stroke, but how this syndrome and the subsequent associated diseases develop is unclear. Now, Franco et al. have analyzed data collected between 1987 and 1998 from 3,078 subjects who participated in the Framingham Offspring Study, to dissect the evolution of metabolic syndrome and its various components. All participants were examined three times, once each between 1987–1991, 1991–1995, and 1995–1998. During this period, the prevalence of metabolic syndrome in the cohort nearly doubled, and more than 77% of subjects diagnosed with the syndrome had high blood pressure. Furthermore, among individuals who did not have metabolic syndrome when examined between 1987–1991 but did when they were assessed at a future check-up, the symptom triad that was most prevalent was large waist circumference:high blood pressure:hyperglycemia (29%), followed by high blood pressure:low HDL cholesterol:high triglycerides (27.1%) and large waist circumference:high blood pressure:high triglycerides (25.0%). The researchers also assessed the likelihood of mortality or the development of heart disease when subjects displayed various combinations of metabolic syndrome symptoms. The large waist circumference:high blood pressure:hyperglycemia triad conferred the greatest risk of developing cardiovascular disease, while this triad and one other (high blood pressure:low HDL cholesterol:high triglycerides) could predict mortality. These data may allow physicians to identify patients destined to develop metabolic syndrome, so that treatment can begin early in the evolution of these dangerous diseases.

O. H. Franco et al., Trajectories of entering the metabolic syndrome. Circulation 120, 1943–1950 (2009). [Abstract]

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