Metabolic syndrome: at the crossroads of cardiorenal risk

The metabolic syndrome (MS), a cluster of cardiovascular risk factors closely linked to insulin resistance whose prevalence is high and rapidly rising in the Western population, has been recognized as a predictor of diabetes and future cardiovascular disease in the general population, as well as in various clinical settings. There is evidence that the MS increases cardiovascular risk, independently from the concomitant effect of several traditional cardiovascular risk factors. Emerging data suggest that MS might also be a risk factor for chronic kidney disease, although its effects on the emergence of chronic kidney disease or its progression beyond the contribution of dys-glycemia and high blood pressure are far from being established with certainty. The concept of the MS has been a topic of lively discussion, given its controversial pathogenesis and clinical usefulness, and several important conceptual and practical drawbacks in its definition raise questions regarding its utility as a risk stratification tool. Nevertheless, the definition of MS has gained wide popularity in the clinical arena as a simple, practical tool for identifying those patients with multiple metabolic risk factors associated with insulin resistance that impart an increased cardiovascular risk not adequately considered by the traditional cardiovascular risk factors. Identification of the MS may help clinicians to move away from a strategy based on single risk factors to one that focuses on multiple risk factors and may increase the awareness of both physicians and patients regarding the cardiovascular importance of targeting metabolic risk factors through weight reduction and exercise.