The metabolic syndrome: should current criteria influence clinical practice?

Many studies have recommended use of metabolic syndrome as an 'alternative' means to assess vascular disease risk, but few have been rigorous, leading to confusion amongst physicians regarding risk screening. This review critically appraises this evidence and also evaluates the data linking metabolic syndrome to type 2 diabetes.

Although presence of metabolic syndrome predicts vascular events, such prediction is inferior and does not enhance simpler Framingham-based risk scores which can be determined using nonfasting blood samples. The dichotomous nature of metabolic syndrome criteria and lack of age, low-density lipoprotein cholesterol, and smoking in part account for their inferior predictive ability. Metabolic syndrome criteria better predict type 2 diabetes but diabetes screening, if adopted, will likely require a two-stage process, with the first stage not dependent on blood sampling. Nevertheless, recent interest in metabolic syndrome has contributed to greater interaction between diabetologists and cardiologists and highlighted more strongly the relevance of obesity to vascular risk.

Best evidence suggests that current metabolic syndrome criteria should not be used as an alternative to established charts for risk prediction for vascular disease. Clinical focus should remain on established risk factors to determine and reduce risk of vascular events.