Obesity, Risk Factors, and Predicting Cardiovascular Events

Abstract

A PubMed search in March 2005 with the key word “metabolic syndrome” yielded >10 000 references. Past labels for this disorder include “syndrome X,” “deadly quartet,” and “cardiovascular dysmetabolic syndrome.”1–3 What is driving the current increased interest in the metabolic syndrome? Possibly the impetus comes from the dramatic increases in obesity in the United States and other developed countries.4 This pandemic has been blamed variously on fast food, high-fat foods, low-fat foods, overreliance on the automobile, television, the Internet, homes in which both parents work, unsafe streets, the disappearance of physical education from the K–12 school curriculum, neighborhoods unsuitable for walking, and some or all of the above. An extensive and consistent body of evidence predicts that accompanying this increase in obesity will be increases in insulin resistance/diabetes, hypertension, hypertriglyceridemia, and decreased HDL cholesterol, as well as unfavorable changes in endothelial function and a host of inflammatory, thrombotic, and fibrinolytic factors. Thus, there is, indeed, reason for concern. See p 1883 In this issue of Circulation , Tanko and colleagues5 attempt a simplification of the National Cholesterol Education Program–Adult Treatment Panel III definition of metabolic syndrome (MS-NCEP) in postmenopausal women. They report that the combination of an enlarged waist and “elevated” triglycerides (EWET; e nlarged w aist, e levated t riglycerides), as compared with the MS-NCEP, was equally prevalent, somewhat more predictive of cardiovascular disease (CVD) death, and somewhat more predictive of abdominal aortic calcium (AAC) progression. Their argument is carefully researched and presented but may strike the reader as …