Evaluating CMR

An ongoing debate

The usefulness of diagnosing the metabolic syndrome in clinical practice is the subject of an ongoing debate. It is well accepted that certain individuals without traditional cardiovascular disease (CVD) risk factors are at risk if they have intra-abdominal (visceral) obesity or insulin resistance (or both). This population at risk for CVD and type 2 diabetes needs to be identified and treated to lessen the burden associated with features of the metabolic syndrome. Twenty years ago, these individuals were largely undiagnosed. However, the identification by Reaven (1) in 1988 of a cluster of metabolic abnormalities associated with insulin resistance (syndrome X) paved the way for a plethora of metabolic, clinical, and epidemiological studies aimed at defining, diagnosing, treating, and identifying the underlying causes of the metabolic syndrome. These abnormalities have also been identified as a target for pharmacotherapy, a topic that has sparked criticism and heated debate (2).

Faced with widespread interest in the metabolic syndrome by the medical field and lay press, in 2005 the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a joint statement calling for caution in diagnosing the metabolic syndrome and questioning its clinical relevance. These two organizations also jointly stated that much more research was needed before this cluster of abnormalities could rightly be called a “syndrome” (3).