Are there mild and serious metabolic syndromes? The need for a graded diagnosis

Metabolic syndrome is an increasingly incident complex metabolic disorder, affecting around 30% of adults in the USA as well as in Europe. In a meta-analysis that evaluated cardiovascular risk associated with the third National Cholesterol Education Program definition of metabolic syndrome in 951 083 patients, metabolic syndrome was associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, all cardiovascular lethal and nonlethal cardiovascular diseases, and a 1.5-fold increase in the risk of all-cause mortality.In this context, the article in this issue of the Journal of Cardiovascular Medicine further stresses the concept that a 'full' metabolic syndrome, including all or almost all its potential components, is associated with an earlier and more serious organ damage, at both cardiac and vascular levels, than the standard definition of metabolic syndrome on the basis of the presence of three out of five components. Moreover, it confirms the central role of waist circumference as the main metabolic syndrome component associated with early organ damage in the enrolled patients, in whom increased waist circumference could be considered as the clinical phenotype of insulin resistance. These data are relevant because they stress the need for a further definition of metabolic syndrome on the basis of its main clinical characteristics (i.e. insulin-resistance/central obesity) and a fix constellation of associated factors (i.e. mild hypertension, atherogenic dyslipidemia) in order to clearly identify those individuals needing a more aggressive diagnostic and therapeutic approach.