Metabolic Syndrome - Ignore Term, Pay Attention to Related Risks

April 7, 2006

There is no clinical utility in making a diagnosis of metabolic syndrome, according to Gerald Reaven, MD, professor of medicine emeritus, Stanford University, Palo Alto, CA. "Metabolic syndrome is not meant to be a diagnostic category," he told internists here at the American College of Physicians Annual Session. Physicians are well advised to treat patients for the individual risk factors associated with the syndrome such as dyslipidemia and hypertension rather than wait for a patient to have all of the risk factors and thus qualify for a definition of the syndrome, he suggested.

There is no clinical utility in making a diagnosis of metabolic syndrome, according to Gerald Reaven, MD, professor of medicine emeritus, Stanford University, Palo Alto, CA. "Metabolic syndrome is not meant to be a diagnostic category," he told internists here at the American College of Physicians Annual Session. Physicians are well advised to treat patients for the individual risk factors associated with the syndrome such as dyslipidemia and hypertension rather than wait for a patient to have all of the risk factors and thus qualify for a definition of the syndrome, he suggested.

The problems for clinicians posed by metabolic syndrome starts with its definition. The World Health Organization (WHO), the National Cholesterol Education Program Adult Treatment Program III (ATP III) and the American Diabetes Foundation (ADF) all have different definitions. "The three versions all have arbitrary criteria and arbitrary cut points. They also are not based on clinical studies but on opinions," said Reaven.

Reaven also noted that some of the elements of the definitions are not useful to the clinician. The WHO definition, for instance, includes the criteria of having both type 2 diabetes and insulin resistance. ""If you have type two diabetes, then you definitely have insulin resistance, so including both in the definition is not needed," he noted.