On November 5, a symposium on cardiometabolic risk was held at the AHA meeting in Orlando. The symposium was co-chaired by Drs. Peter Libby and Ronald Krauss and was very well attended. Symposium contributors included AHA past president Dr. Robert Eckel, chairman of the NCEP-ATPIII guidelines Dr. Scott Grundy, and scientific director of the International Chair on Cardiometabolic Risk Dr. Jean-Pierre Després.
In his lecture, Dr. Eckel described issues relevant to the debate on the metabolic syndrome. While he acknowledged that some of the criticisms levelled against the syndrome are relevant and helpful, he also stressed that the metabolic syndrome provides a simple and clinically relevant way to screen for individuals with a cluster of athero-thrombotic and inflammatory abnormalities that increase the risk of diabetes and cardiovascular disease. Dr. Eckel also discussed the notion that insulin resistance is a core component of metabolic syndrome abnormalities before providing an overview of its pathophysiology. Dr. Eckel closed by acknowledging the importance of healthy nutrition and physical activity and by briefly reviewing therapeutic options for pharmacological management of the metabolic syndrome.
Dr. Grundy presented the rationale for the use of metabolic syndrome criteria. He also noted that a distinction should be made between the conceptual definition of the metabolic syndrome and the five criteria for its diagnosis. These criteria are not a definition of the metabolic syndrome per se but are rather tools to identify individuals likely to have this constellation of atherogenic and diabetogenic metabolic abnormalities. He also introduced the notion of a “double hit” in the pathophysiology of the metabolic syndrome. Under this model, the first hit is caused by the sedentary lifestyle and poor quality, energy-dense diet that leads to obesity. The second hit is visceral and ectopic fat deposition and insulin resistance, which may represent the dysfunctional adipose tissue that leads to the metabolic syndrome. Dr. Grundy also stressed in his lecture that the metabolic syndrome concept was developed to emphasize to patients that they need to eat better and be physically active.
Dr. Després also acknowledged that the introduction of the metabolic syndrome was a giant conceptual leap forward. This concept emphasizes that abdominal obesity and related metabolic abnormalities can increase CVD risk beyond that conferred by classical risk factors. While he recognized that clinical diagnosis of the metabolic syndrome is not sufficient to assess global CVD risk, he also stressed that measuring some simple clinical features of the metabolic syndrome, such as waist and triglyceride levels, is essential to identify a subgroup of individuals at greater risk of CHD than can be estimated using the Framingham risk score. Dr. Després also defined cardiometabolic risk (not to be confused with the metabolic syndrome), which is simply the global risk of cardiovascular disease resulting from the presence of classical risk factors plus the additional risk associated with the metabolic syndrome.
The findings and ideas discussed during this symposium will hopefully spur further studies and constructive discussions to better equip health professionals to optimally assess and manage the global cardiometabolic risk of their patients. In this regard, symposium participants agreed that abdominal obesity and the metabolic syndrome remain valid health concerns.