[Metabolic syndrome--a high cardiovascular risk?]

Our knowledge about risk factors of atherosclerosis and their associations has considerably changed and improved. The importance of type 2 diabetes and hypertension was detected earlier, hyperlipidemia and dyslipidemia (disturbance of lipoprotein composition) have been recently implemented. We have learnt that the android obesity form and especially visceral fat serve as central trigger-factor of the resulting "metabolic syndrome" and other related disturbances like acute phase proteins, inflammation markers and procoagulatory state. Altogether atherothrombotic events are increased and result in clinically relevant macrovascular disease (myocardial infarction, cerebrovascular und peripheral arterial disease), blood glucose itself causing additionally microvascular disease. The newest comprehensive guidelines of European Associations try to use most of the known factors for treatment guidelines but will fail due to the fact that they cannot be easily used in clinical practice. In additon, visceral fat, that central factor, and body fat mass have not been integrated. We suggest that the risk should be evaluated in the context of body mass index (BMI) and especially of waist circumference which could be THE central intervention factor in the treatment of our patients.