COMMENTARY

Further Analysis of INTERHEART: What Do the Data Tell Clinicians?

Arya Sharma, MD

Disclosures

January 19, 2006

In This Article

Metabolic Syndrome: Bringing It All Together?

In addition to BMI, the other current measure of metabolic risk comprises the cluster of clinical abnormalities known as the "metabolic syndrome."

The Third Report of the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III)[8] defines metabolic syndrome as being characterized by any 3 of the following traits:

  • High blood pressure (> 135/> 85 mm Hg)

  • Low HDL-cholesterol (< 40 mg/dL for men and < 50 mg/dL for women)

  • Elevated triglycerides (> 150 mg/dL)

  • Elevated fasting glucose (> 110 mg/dL)

  • Abdominal obesity (waist circumference > 102 cm (> 40 in) for men and > 88 cm (> 35 in) for women

The important point here is that the low-density lipoprotein (LDL)-cholesterol level may be well within the normal range, but when any 3 of the above traits are seen concomitantly with a normal LDL level, the patient is defined by ATP III as presenting with metabolic syndrome. As a stimulus to clinicians to recognize that a normal LDL level may not mean an absence of cardiovascular risk, the concept of a metabolic syndrome has a practical usefulness. However, the 9 factors determined by INTERHEART to be predictive of almost the entirety of CVD risk encompass the constituents of metabolic syndrome (as defined by ATP III), and the results of our subanalysis show that of those 9 factors, assessing abdominal obesity will be more useful than a diagnosis of "metabolic syndrome" for assessing future risk in our cardiovascular patients.

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