From Syndrome to Spectrum: What Evolution Suggests about the Status of the Metabolic Syndrome

In 2005 the American Diabetes Association and European Association for the Study of Diabetes questioned the value of the metabolic syndrome as a diagnostic category(1). In the same year, Reaven delivered a noted “obituary” for the metabolic syndrome in this journal, while defending the insulin resistance syndrome as a pathophysiologic entity(2). But despite these broadsides, the concept of the metabolic syndrome is attracting continued support. PubMed lists 1775 articles with “metabolic syndrome” in the title or abstract published during 2005, 2566 during 2006, and 1689 for the first 6 months of 2007. Clearly, rumors of the syndrome’s demise have been greatly exaggerated. There are several reasons why the metabolic syndrome continues to thrive as a concept. First, there is a widespread sense that its components are sufficiently coupled mechanistically to suggest some kind of disease entity. Second, the term and concept retain utility simply for want of a fuller description of the underlying pathology. Third, the concept is self-sustaining, in that the existing body of research attracts further research and comment. Fourth, industry promotes the syndrome in symposia and review articles, alongside related concepts such as the “cardiometabolic syndrome” and “cardiometabolic risk”.