Does the metabolic syndrome add to the diagnosis and treatment of cardiovascular disease?

Abstract

Much controversy has surrounded both the pathological basis and the clinical utility of the metabolic syndrome. Key questions still revolve around the definition of this syndrome, its utility as a predictor of cardiovascular risk, and the treatment implications of diagnosis. The metabolic syndrome is associated with increased cardiovascular risk. However, the metabolic syndrome clearly underperforms compared with other, established prediction equations, such as the Framingham Risk Score and SCORE (Systemic COronary Risk Evaluation). Differences arise because the components are highly correlated (whereas other tools specifically include independent predictors) and because diagnosis is based on dichotomized variables. These facts, together with uncertain pathophysiology, mean that the metabolic syndrome in its current manifestation has limited utility for the diagnosis and treatment of cardiovascular disease. The syndrome has, however, served and continues to serve a useful purpose in raising awareness of the metabolic consequences of obesity, and as a spur for research into metabolic risk factor interactions.

Key Points

• Metabolic syndrome is associated with increased cardiovascular risk

• The total risk associated with metabolic syndrome might be greater than that of its component parts, although the evidence for this is not clear

• Metabolic syndrome performs poorly compared with tools designed specifically to identify individuals at increased cardiovascular risk

• There is no single mechanism that underlies the pathophysiology of the metabolic syndrome, and pharmacological treatment should, therefore, be restricted to treating individual risk factors according to established guidelines