[On the concept of the metabolic syndrome]

During the last twenty years, a cluster of risk factors called metabolic syndrome (MetS) attracts interest in preventive medicine. According to the prevailing notion, which evolved from clinical observations, the core of the MetS consists of visceral obesity, impaired metabolism of glucose, atherogenic dyslipidemia, and arterial hypertension. These risk factors tend to cluster and are believed to be causally associated with insulin resistance. Components of the MetS are to a various degree involved in chronic inflammation, prothrombotic state, endothelial dysfunction, and oxidative stress. Supporters of the concept of MetS as a physiological and clinical entity believe that systems approach can help in understanding pathogenesis, improve prediction of cardiovascular risk, and increase motivation for prevention and treatment. On the other hand, serious criticisms emerged, which concern insufficient experimental evidence, imprecise diagnostic criteria, and questionable justification in general practice. To clarify unresolved problems which evolved in the ongoing debate, further research is needed.