Revisiting the metabolic syndrome

Metabolic syndrome (MS) refers to the clustering of cardiometabolic risk factors — including abdominal obesity, hyperglycaemia, dyslipidaemia and elevated blood pressure — that are thought to be linked to insulin resistance. MS is associated with increased risk of cardiovascular disease and type 2 diabetes. MS is common, affecting a quarter to a third of adults, and its prevalence is rising, in parallel with increasing obesity and population ageing. Operational definitions of MS have been proposed by the World Health Organization and the National Cholesterol Education Program. Recently, the International Diabetes Federation proposed a global definition that emphasised the importance of central adiposity. In cardiovascular risk assessment, MS encapsulates the contribution of non‐traditional risk factors and provides a clinically useful framework for early identification of people at increased long‐term risk. It should be used in conjunction with standard algorithms based on conventional risk factors, which better predict short‐term risk. Management of MS should emphasise lifestyle interventions (eg, physical activity, healthy diet and weight reduction) to reduce long‐term risk of cardiovascular disease and diabetes. Those at increased short‐term risk should also have individual risk factors treated according to established guidelines.