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The metabolic syndrome (syndrome X, insulin resistance syndrome) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus. Evolution of the criteria for the metabolic syndrome since the original definition by the World Health Organization in 1998 reflects growing clinical evidence and analysis by a variety of consensus conferences and professional organizations. The major features of the metabolic syndrome include central obesity, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, hyperglycemia, and hypertension (Table 401-1).

TABLE 401-1NCEP:ATPIIIa 2001 and Harmonizing Definition Criteria for the Metabolic Syndrome


image The most challenging feature of the metabolic syndrome to define is waist circumference. Intraabdominal circumference (visceral adipose tissue) is the most strongly related to insulin resistance and risk of diabetes and CVD, and for any given waist circumference the distribution of adipose tissue between subcutaneous (SC) and visceral depots varies substantially. Thus, within and between populations, there is a lesser vs greater risk at the same waist circumference. These differences in populations reflect the range of waist circumferences considered to confer risk in different geographic locations (Table 401-1...

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