Friday, October 9, 2009
New Joint Statement Streamlines Definition of Metabolic Syndrome
From Heartwire, by Michael O'Riordan
October 8, 2009
(Brussels, Belgium) — A new joint statement from a number of professional
organizations has identified specific criteria for the clinical diagnosis of the
metabolic syndrome, tightening up the definition, which previously differed from
one organization to the next [1].
The statement,
published online October 5, 2009 in Circulation, includes the
participation of the International Diabetes Federation (IDF), the
National Heart, Lung, and Blood Institute (NHLBI), the World Heart
Federation, the International Atherosclerosis Society, and the
American Heart Association (AHA) and is an attempt to eliminate some of
the confusion regarding how to identify patients with the syndrome.
Specifically, the
new metabolic-syndrome definition streamlines previous differences related to
abdominal obesity as defined by measurements in waist circumference. Substantial
disparities existed between the previous IDF and the ATP III definitions of what
constituted an excessively large waist circumference, by as much as 8 cm between
the two groups, but these have been amended. Now, the criteria for elevated
waist circumference are based on population- and country-specific definitions,
which, although streamlined, do leave some work to be done, said Eckel.
The new definition
relies on different geographic regions, or different countries, to drill down
into their own databases in terms of relating waist circumference to risk.
Now, waist circumference is just one of five criteria that
physicians can use when diagnosing the metabolic syndrome.
Patients with three
of the five criteria--including elevated waist circumference, elevated
triglycerides, reduced HDL-cholesterol levels, elevated blood pressure, and
elevated fasting-glucose levels--are considered to have the syndrome.
Criteria for
Clinical Diagnosis of the Metabolic Syndrome
Measure | Categorical cut points |
Elevated waist circumference | Population- and country-specific definitions |
Elevated triglycerides (drug treatment for elevated triglycerides is an alternate indicator) | >150 mg/dL |
Reduced HDL cholesterol (drug treatment for reduced HDL cholesterol is an alternate indicator) | <40> |
Elevated blood pressure (drug treatment for elevated blood pressure is an alternate indicator) | Systolic >130 mm Hg and/or diastolic >85 mm Hg |
Elevated fasting glucose (drug treatment for elevated glucose is an alternate indicator) | >100 mg/dL |
Notably absent from
the joint statement is the American Diabetes Association--there are
unresolved scientific issues between the ADA and other associations, including
the AHA, regarding the metabolic syndrome.
Specifically, the
ADA, as well as the European Association for the Study of Diabetes
(EASD), objected to the manner in which the metabolic syndrome was
characterized as a risk factor for heart disease or diabetes, arguing that there
was no need to diagnose a patient with the syndrome because emphasis should be
placed on aggressively treating the individual risk factors.
In 2005, the ADA
and EASD issued their own joint statement calling for a critical appraisal of
the metabolic syndrome, its designation as a syndrome, and its clinical
utility.
Be aware and be
well!
Dr.D
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