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Invited Commentary
March 8, 2010

The Metabolic Syndrome as a Cluster of Risk Factors: Is the Whole Greater Than the Sum of Its Parts?Comment on “The Metabolic Syndrome, Its Component Risk Factors, and Progression of Coronary Atherosclerosis”

Author Affiliations

Author Affiliations: Departments of Nutrition (Drs Ding and Hu) and Epidemiology (Dr Hu), Harvard School of Public Health, Boston, Massachusetts; and Institute for Health Sciences (Ms Smit), VU University, Amsterdam, the Netherlands.

Arch Intern Med. 2010;170(5):484-485. doi:10.1001/archinternmed.2009.552

From the conception of MetS, much debate has continued regarding the recognition of MetS as a real syndrome and whether it is an informative clinical tool. Supposedly, the MetS combination of 3 of its 5 components (hypertriglyceridemia, hyperglycemia, hypertension, low HDL-C level, and greater waist circumference/adiposity) should not only be helpful in identifying cardiovascular disease (CVD) risk but also represent symptoms of an underlying disease or condition.

Two main questions now persist: (1) whether MetS improves prediction and better characterizes people at risk of CVD rather than simply identifies the presence of the individual component risk factors, and (2) whether the syndrome possesses an underlying pathophysiologic characteristic or is merely an aggregated post hoc collection of correlated cardiovascular risk factors.