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J Am Coll Cardiol, 2006; 47:1093-1100, doi:10.1016/j.jacc.2005.11.046 (Published online 21 February 2006).
© 2006 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds

Scott M. Grundy, MD, PhD*,*

Center for Human Nutrition and Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Manuscript received October 6, 2005; revised manuscript received October 28, 2005, accepted November 1, 2005.

* Reprint requests and correspondence: Dr. Scott M. Grundy, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Y3.206, Dallas, Texas 75390-9052. (Email: scott.grundy{at}utsouthwestern.edu).

The metabolic syndrome is a constellation of risk factors of metabolic origin that are accompanied by increased risk for cardiovascular disease and type 2 diabetes. These risk factors are atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a proinflammatory state. The two major underlying risk factors for the metabolic syndrome are obesity and insulin resistance; exacerbating factors are physical inactivity, advancing age, and endocrine and genetic factors. The condition is progressive, beginning with borderline risk factors that eventually progress to categorical risk factors. In many patients, the metabolic syndrome culminates in type 2 diabetes, which further increases risk for cardiovascular disease. Primary treatment of the metabolic syndrome is lifestyle therapy—weight loss, increased physical activity, and anti-atherogenic diet. But as the condition progresses, drug therapies directed toward the individual risk factors might be required. Ultimately, it might be possible to develop drugs that will simultaneously modify all of the risk factors. At present such drugs are in development but so far have not reached the level of clinical practice.

Abbreviations and Acronyms
  ASCVD = atherosclerotic cardiovascular disease
  ATP III = Adult Treatment Panel III
  CB1 = cannabinoid receptor-1
  HDL = high-density lipoprotein
  IDF = International Diabetes Federation
  LDL = low-density lipoprotein
  NCEP = National Cholesterol Education Program
  PPAR = peroxisome proliferator-activated receptor
  TZD = thiazolidinedione
  WHO = World Health Organization




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