Dallas, TX - The American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) have teamed up to produce a scientific statement on the diagnosis and management of metabolic syndrome [1].

The panel behind the statement, which was published online in Circulation on September 12, 2005, was chaired by Dr Scott Grundy (University of Texas Southwestern Medical Center, Dallas) and included AHA president Dr Bob Eckel (University of Colorado, Denver).

In an interview with heartwire, Eckel said that the new statement had "nothing to do" with the recent statement issued by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) discouraging the use of the term "metabolic syndrome." "Our [statement] is just a routine update. It had been planned for a long time and was in press before the ADA/EASD issued their statement," he said. He noted that the new AHA/NHLBI statement was based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) report published in 2001 [2]. He added that there were only a few differences from the ATP III report.

Grundy elaborated to heartwire that the new AHA/NHLBI statement was simply "putting together a more complete picture" than was available in the ATP III report. "We have tweaked the definitions of each component of metabolic syndrome a little," he said. But Grundy stressed that he strongly disagreed with the ADA /EASD stance that the clustering of risk factors known as metabolic syndrome is not important. "This report strengthens the position that metabolic syndrome is important," he says.

"The ADA is saying that we should just treat each risk factor and it is not important that they cluster together. This used to be the position of the cardiovascular community, but now we all recognize the importance of a multiple-risk-factor approach, and metabolic syndrome is in the middle of the multiple-risk-factor approach. We in cardiovascular medicine know that you can't deal with these things in isolation. From our perspective, the ADA is 10 years out of date on this," he commented.

As in the previous ATP III report, the AHA/NHLBI statement notes that an individual who has abnormal levels of three of the following should be considered to have metabolic syndrome:

• Elevated waist circumference (abdominal obesity).
• Elevated triglycerides.
• Reduced HDL cholesterol.
• Elevated blood pressure.
• Elevated fasting glucose.

It notes that metabolic syndrome increases the risk of atherosclerotic cardiovascular disease 1.5- to 3-fold, and raises the risk for type 2 diabetes 3- to 5-fold. It affects more than 26% of adults, or more than 50 million Americans.

New features of the latest statement include:

• Adjustment of the waist-circumference criterion to lower thresholds in individuals or ethnic groups, such as Asian Americans, who are prone to insulin resistance.
• The suggestion that triglycerides, HDL levels, and blood pressure be considered abnormal, even when a person is on drug treatment for these risk factors.
• Clarification of the definition of elevated blood pressure—the level that exceeds the threshold for either systolic or diastolic blood pressure (130/85 mm Hg).
• Bringing the ATP III criteria for elevated fasting glucose down from 110 mg/dL to 100 mg/dL in accord with the ADA's revised definition of impaired fasting glucose.