The Metabolic Syndrome

Abstract

See related article, pages 1078–1083. The metabolic syndrome is a clustering of metabolic abnormalities, which include insulin resistance or diabetes, obesity, hypertension, and dyslipidemia. Although the mechanisms of the underlying abnormalities remain to be clarified, the pathogenesis includes both genetic predisposition and modifiable risk factors such as sedentary lifestyle and dietary intake. Recent estimates suggest that approximately 24% of US adults have the metabolic syndrome.1 In several studies, the metabolic syndrome has been shown to increase the risk of cardiovascular diseases2; however, the strength of its association with stroke is weaker than that for coronary heart disease.3 In the guidelines for the primary prevention of stroke from the American Heart Association/American Stroke Association, the metabolic syndrome is listed as a less–well-documented risk factor.4 But, given the high prevalence of the metabolic syndrome, studying its association with stroke is certainly relevant for 2 reasons: first, to obtain a better etiologic understanding of the causes of stroke; second, to identify individuals at high risk for stroke. This translates into 2 distinct scientific questions: is the metabolic syndrome by itself a risk factor for stroke?; and can we predict which individuals are at increased risk for stroke based on information about the metabolic syndrome? To answer these questions from observational data, one needs 2 distinct model-building strategies that require differences in assumptions of biological associations and statistical considerations.5,6 In this issue of Stroke ,7 Wang and …