The Future of the Metabolic Syndrome

In the early part of the twentieth century the aggregation of multiple cardiovascular risk factors was observed in a growing number of patients [1] followed by an increasing prevalence of a cluster of diseases – obesity, type 2 diabetes, hypertension, and dyslipidemia – which are closely interrelated and strongly depend on environmental factors [2] [3]. More recently, however, similar clustering has received renewed attention and several terms such as syndrome X, insulin resistance syndrome, and metabolic syndrome were used to describe this cluster. Recently, Metabolic Vascular Syndrome (MVS) was proposed to describe the connection between obesity, insulin resistance, hypertension, dyslipidemia, type 2 diabetes mellitus, and atherosclerotic cardiovascular disease. Pathophysiological debates led to the hypothesis that type 2 diabetes and cardiovascular diseases both arise from common antecedents like abdominal obesity, insulin resistance, dyslipidemia, hypertension etc., since the latter rarely occur isolated in our patients. The biological mechanisms remain unclear. Plausible pathophysiological mechanisms involve direct neuroendocrine effects and indirect effects mediated by adverse health behaviors. Despite this well-known association, the definition of metabolic syndrome varies in terms of the indicators that are used and the cut-points that are required to make the diagnosis. Recently, the society has been witnessing not only the rise of a new era in the prevention and treatment of the metabolic syndrome and cardiovascular disease but also confronting a discussion about the added value of the term metabolic syndrome. The socioeconomic burden of the syndrome and its mortality are driven by the cardiovascular part of the syndrome, and the morbidity is driven by the metabolic part.

With the present special issue of Hormone and Metabolic Research we would like to add value to the current debate, following the discussions which particularly took place during the 3rd International Symposia “The Metabolic Syndrome – a Postprandial Disease” in Dresden, Germany between May 23–25th, 2008 following the previous symposia in 2007 and 2005 [4] [5]. We want to address the metabolic vascular Syndrome as a global health problem but having globally different facets and challenges [6] [7] [8]. What are the strategies, targets and societal needs, which significantly enhance the ability of health care professionals to respond swiftly to the global epidemic of the metabolic vascular syndrome and its burden to the society? Should we focus on differentiated treatment addressing all facets of the syndrome after it is diagnosed? Is the investment in setting oriented efficient screening strategies [9] for metabolic syndrome risk factors [10] [11] and development of intervention strategies for the primary prevention the right answer [12]?

The pathophysiology of the metabolic syndrome needs to be further elucidated. At the symposia in 2008 the Metabolic Vascular Syndrome was presented in its basic [13], endocrine [14], physiologic aspects [15] as well as its clinical aspects [16] related to atherosclerosis [17], cardio vascular [18] and metabolic disease and diagnostic [19] and treatment challenges [20] and preventive aspects [11]. For clinical routine, however, it is helpful to summarize the clinical spectrum under a unifying, presently well accepted definition of the metabolic syndrome. Our symposium has been focused on psychological and socio-cultural aspects and postprandial dysregulation as early manifestation of the metabolic syndrome.

From the public health perspective the high prevalence of metabolic syndrome signals worldwide an urgent need to focus on efforts how to control the obesity epidemic and improve physical activity levels within the populations. There is a clear consensus amongst healthcare professionals that action is urgently needed on political and community levels. The challenge is to implement proven intervention, diagnostic and treatment methods effectively into clinical reality. To achieve this, action is needed not only in the field of policy development but also in the development of targeted intervention programs, which address the needs of people with an metabolic vascular syndrome, clinical- and community-based healthcare professionals, and the general population.

References

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