[Metabolic syndrome: limited significance for clinical practice]

The risk factors for diabetes and cardiovascular disease are clustered in the 'metabolic syndrome'. The introduction of working definitions of this syndrome, all including dyslipidaemia (high triglycerides and low HDL cholesterol level), hypertension, hyperglycaemia and a measure of fat distribution or obesity, has enabled descriptive studies. Prospective population studies report an approximately two-fold increased risk of cardiovascular disease in subjects with the metabolic syndrome, with a linear increase in risk with increasing number of risk factors. So far, there is no solid evidence that insulin resistance is the main cause of the syndrome. A number of alternative or contributing mechanisms have been proposed, including cortisol metabolism and microvascular dysfunction. The concept of the metabolic syndrome has improved public awareness. Its utility in clinical practice, however, is under debate. Reduction of obesity by life-style changes and treatment of individual risk factors is still the best line of action.